In an article being early released this month in Pediatrics, authors from several institutions, led by Carolyn Humphrey, Shoshana Mehler, and Dr. Erica C. Kaye, studied conversations between pediatric oncologists and their patients and families, aiming to identify language strategies that could inform teaching and promote the practice of dignity-centered communication (10.1542/peds.2023-065559). This work is part of a longitudinal prospective study, The Understanding Communication in Healthcare to Achieve Trust (U-CHAT) study, examining communication between pediatric oncologists and children and young adults with poor-prognosis cancers and their families.
Although the authors readily concede that “dignity” is challenging to define and measure, it is widely acknowledged as being critical to meaningful interaction, particularly in the face of medical suffering and illness.
The authors cite key literature that dignity in patient care is underpinned by three concepts:
- Empowerment—including self-esteem, self-worth and pride
- Autonomy—including control, choice and independence
- Respect—including honoring patient/family goals and personhood beyond the cancer
In this article, conversations of 63 parent-child dyads with a medical oncologist were recorded. Of these, 91 medical discussions with 36 of the dyads and their medical oncologists occurred at the point of disease relapse or progression; these were analyzed for dignity-centered language. The study team anchored their codebook with the themes above, reviewed the recordings, and worked through 4 steps with 5 analysts to create categories within the themes that encompassed the recorded clinician language.
Using both a “glass half full” and “glass half empty” look at results, the authors found that
- Just over half (55%) of encounters did include a statement supporting dignity, and
- Almost all oncologists (12 of 13, 92%) used at least one statement referencing dignity, but
- Fewer than 7% of recorded dialogue included dignity-centered language.
Given that 45% of these critical oncology conversations included no statements promoting dignity, the authors emphasize this represents an opportunity to improve how often and with what words oncologists can bring empowerment, autonomy, and respect into their patient care. Future research including patient and family perspectives is essential to this approach.
But this study is not just for pediatric oncologists! Table 3 includes multiple example quotes that can both inspire and provide scripting that is easily adapted for an office setting. Each of us can take this patient-centered approach and run with it in our many conversations with patients and families about a multitude of other topics, from vaccines to parenting to teen sexuality. Let us know what you took home from this excellent study.
