When cancer is suspected
It is good practice to gently explain to families that a cancer diagnosis is suspected, or needs to be ruled out, before transferring them to a cancer unit. This allows them a chance to prepare themselves before arriving and prevents the shock of realising themselves the speciality to which they have been referred. It is important to provide the family with information about how to get to the Principal Treatment Centre, which ward to go to, and what they might see, i.e. children being treated for cancer, some of whom will not have hair.
When a cancer diagnosis is confirmed
When diagnosis is confirmed, the child or young person (CYP) will most often be present in the consultation and age-appropriate language will be used. If they are not present, we encourage and support the family to be open and honest with their child and explain the diagnosis to them as soon as possible, using words such as cancer, leukaemia and chemotherapy from the outset. Children and young people realise very quickly that there is something seriously wrong and if the “wool is being pulled over their eyes.” If the child can read, they will see these words everywhere around the unit. Very small children quickly get used to the new language.
Talking to a family after a diagnosis has been made
When meeting a newly diagnosed family for the first time, it is perfectly acceptable to say if it is not an illness you have come across often, if at all. You could ask them to “tell their story” and what / how much the child or young person understands.
If there has been recent contact with the patient before diagnosis, it is important to the family to acknowledge this. Some families may present with anger around the process of diagnosis. Try to listen and empathise with the difficulties of their experience: this often allows them to move on and facilitates the continuation of a professional relationship.
If this conversation has arisen at the Children’s Cancer Centre, it will have been explained to the family just how rare it is for a professional outside the speciality to come across a child or young person with cancer. Ask them how they are coping and if there is anything they think you could help with.
Sage and Thyme training, which offers staff a structured approach on how to manage difficult conversations whilst allowing the conversation to be patient-led, is available in some Health boards and Trusts
Links to further reading and guidance on breaking bad news
Breaking Bad News Website covering many aspects of communicating bad news
Breaking bad news: Supporting parents when they are told of their child's diagnosis Guidance for nurses, midwives and health visitors from the Royal College of Nursing