550 - The Dynamics of Parent-Clinician Communication During Diagnostic Cancer Conversations in Guatemala

Effective communication is essential for high-quality medical care, helping clinicians meet families’ needs, promoting treatment adherence, and building the family-clinician relationship. Research in adult medicine suggests that communication is impacted by limited literacy and socio-economic status; however, the relationship between clinician and parent communication styles in global pediatric settings remains poorly understood. 

Objective:

This study aims to investigate the dynamics of clinician communication and parental involvement during diagnostic cancer conversations in Guatemala.

Design/Methods:

This qualitative study followed 20 parents of children with cancer through the diagnostic process at Unidad Nacional de Oncología Pediátrica in Guatemala, an upper-middle income country where 19.2% of the population over the age of 15 is illiterate. Audio recorded psychosocial intakes, diagnosis conversations, and semi-structured interviews were analyzed using a priori and novel codes.

Results:

Participating families represented a range of hematological, solid tumor, and CNS tumor diagnoses. Only 10% of fathers and 5% of mothers participating in the study reported education beyond primary school. Clinicians spoke 68% of words during psychosocial intakes and 85% of words during formal diagnoses. Clinicians used supportive communication techniques including providing explanations, demonstrating verbal attentiveness, and soliciting questions. At times, paternalistic talk by clinicians created a non-supportive presence. Parental speech was coded as active when parents asked questions, expressed hopes or concerns, or asserted their opinions and non-active when they provided demographic information or expressed understanding. Supportive clinician communication often prompted non-active parents to become active participants, while non-supportive communication did not. Active parents remained active regardless of clinician communication. Furthermore, active parent participation often elicited supportive communication from clinicians, while non-active parent participation did not.

Conclusion(s):

Our findings highlight the bidirectional nature of effective communication, establishing that clinician communication styles both influence and are influenced by parental participation. Given the impact of effective communication on patient-centered care and treatment adherence, these findings highlight the importance of supportive clinician communication in global settings.