Most parents of children with cancer form trusting relationships with their children’s oncologists; however, poor outcomes may negatively affect parental trust, according to the results of a prospective questionnaire-based cohort study published in Pediatric Blood & Cancer.
The investigators examined parents’ experiences with trust throughout the first year following a child’s cancer diagnosis at 2 academic pediatric hospitals, Dana-Farber Cancer Institute/Boston Children’s Hospital and Children’s Hospital of Philadelphia, between November 2008 and April 2014.
Trust was evaluated via surveys administered to parents immediately after diagnosis (baseline; 382 parents) and after 4 months and 12 months (longitudinal; 166 parents). Factors associated with trust over time were also analyzed.
The surveys revealed that a majority of parents (71%) trusted their child’s oncologist “completely” at baseline. Similarly, 79% and 77% of parents “completely” trusted their child’s oncologist at 4 months and 12 months, respectively.
At baseline, 2 factors were associated with trust: high-quality physician communication (odds ratio [OR], 4.11; 95% CI, 1.78-9.51; P =.001) and receipt of high-quality information (OR, 2.82; 95% CI, 1.29-6.16; P =.01), after adjustment for parent gender, race/ethnicity, and education.
The parents of children who experienced relapse or progression were significantly less likely to trust the oncologist “completely” at 12 months compared with parents of children who did not experience relapse or progression (53% vs 80%; OR, 0.28; 95% CI, 0.10-0.81; P =.02) in a multivariate model adjusted for parent gender, race/ethnicity, and education.
Similarly, in a model adjusted for parent gender, race/ethnicity, education, and clustering by physician, high-quality communication (OR, 3.40; 95% CI, 1.61-7.20; P =.001) and receipt of high-quality information (OR, 2.48; 95% CI, 1.18-5.21; P =.02) remained positively associated with trust, while relapse or progression (OR, 0.39; 95% CI, 0.17-0.92; P =.03) remained negatively associated with trust. Overall, trust increased with time relative to the baseline (4-months OR, 4.32; 95% CI, 2.12-8.77; P <.0001; 12-months OR, 5.10; 95% CI, 2.10-8.39; P <.0001).
In this study, parents’ trust was not associated with patient’s inherent characteristics or sociodemographic attributes, including parent gender, race/ethnicity, education, child age, or decision-making role, or other factors such as, diagnosis, timing of survey completion relative to diagnosis, or prognosis.
The study was limited by the small number of participating institutions. Additionally, a majority of the parents were White (78%-80%), and not all parents participated in the longitudinal follow-up.
The authors highlighted 4 key takeaways from the study:
1. Oncologists should recognize that parents’ trust in providers is not automatic.
2. In early encounters at/after diagnosis, parents are listening to what providers say and how they say it.
3. If parents are not trusting right away, providers should know that this may improve with time.
4. Because poor outcomes may damage trust, providers should consider sharing prognostic information early as this may lessen the damage to trust if relapse or progression occur.
The authors concluded, “Physicians can foster trust through patient-centered communication and provision of high-quality information about a child’s cancer.”
Mack JW, Kang TI. Care experiences that foster trust between parents and physicians of children with cancer. Pediatr Blood Cancer. Published online August 22, 2020. doi:10.1002/pbc.28399