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2016 ; 138
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): ä Nephropedia Template TP
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Prognostic Disclosures to Children: A Historical Perspective
#MMPMID27561728
Sisk BA
; Bluebond-Langner M
; Wiener L
; Mack J
; Wolfe J
Pediatrics
2016[Sep]; 138
(3
): ä PMID27561728
show ga
Prognostic disclosure to children has perpetually challenged clinicians and
parents. In this article, we review the historical literature on prognostic
disclosure to children in the United States using cancer as an illness model.
Before 1948, there was virtually no literature focused on prognostic disclosure
to children. As articles began to be published in the 1950s and 1960s, many
clinicians and researchers initially recommended a "protective" approach to
disclosure, where children were shielded from the harms of bad news. We
identified 4 main arguments in the literature at this time supporting this
"protective" approach. By the late 1960s, however, a growing number of clinicians
and researchers were recommending a more "open" approach, where children were
included in discussions of diagnosis, which at the time was often synonymous with
a terminal prognosis. Four different arguments in the literature were used at
this time supporting this "open" approach. Then, by the late 1980s, the
recommended approach to prognostic disclosure in pediatrics shifted largely from
"never tell" to "always tell." In recent years, however, there has been a growing
appreciation for the complexity of prognostic disclosure in pediatrics. Current
understanding of pediatric disclosure does not lead to simple "black-and-white"
recommendations for disclosure practices. As with most difficult questions, we
are left to balance competing factors on a case-by-case basis. We highlight 4
categories of current considerations related to prognostic disclosure in
pediatrics, and we offer several approaches to prognostic disclosure for
clinicians who care for these young patients and their families.
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