Explore the vast range of titles available.

Despite growing evidence that narrative expertise may benefit cancer care professionals and the field, few hematology-oncology trainees pursue graduate degrees in the humanities. For those trainees with a particular interest in humanism in medicine, we advocate for integration of a Master of Fine Arts (MFA) degree concurrent with fellowship training. This pathway enables trainees to gain advanced skills in narrative competence, informing research and scholarly activities during fellowship and building a foundation for future careers that promote humanism in the field of hematology-oncology across clinical practice, education, research, and advocacy. Narrative competence describes the ability to create space for and elevate the voices of patients, families, and clinicians, which includes active listening, reflecting, sharing, and being moved by stories. In this paper, we review evidence suggesting that frequent exposure to suffering can threaten career longevity for cancer care clinicians, and we highlight narrative competence as an approach to mitigate moral distress, improve well-being, and bolster resilience for our workforce. The influence of narrative competence extends beyond patient care, with meaningful ramifications for advancing research, education, and advocacy efforts across the field. We encourage institutions with hematology-oncology fellowship programs that have capacity to support graduate studies to include the MFA as an option for trainees who aim to become thought leaders and experts in narrative competence. The MFA serves as a strategic mechanism to invest in growing the next generation of hematologist-oncologists with expertise in narrative competence to advance the field.

Background Most patients with cancer and their caregivers desire honest, clear prognostic communication, yet oncologists often disclose prognosis inconsistently. Prognostic communication becomes even more challenging when disease progression is unclear or equivocal. Presently, oncologist approaches for discussing uncertain disease findings are poorly understood. Methods In this prospective, longitudinal study, we audio-recorded serial disease reevaluation conversations between children with high-risk cancer, their families, and their primary oncologists over 24 months and conducted content analysis at recorded timepoints when oncologists categorized disease progression as equivocal. Results Of the 265 medical discussions recorded across the illness course for 33 patient-parent dyads, a total of 40 recorded discussions took place at equivocal timepoints, comprising > 500 min of medical dialogue. Prognosis talk encompassed < 3% of dialogue and was absent in nearly half of equivocal discussions (17/40, 42.5%). Curability statements were identified in only two conversations. Inductive content analysis of dialogue revealed four distinct patterns for communicating equivocal disease status: (1) up-front reassurance, (2) softening the message, (3) describing possible disease progression without interpretation, (4) expressing uncertainty without discussing the bigger picture. Conclusion Oncologists rarely discuss prognosis with children with high-risk cancer and their families at timepoints when disease progression is not definitive. Formal guidance is needed to better support oncologists in navigating uncertainty while sharing honest, person- and family-centered information about prognosis.

In this scoping review, we evaluated existing literature related to factors influencing treatment decision-making for patients diagnosed with cancer in low- and middle-income countries, noting factors that influence decisions to pursue treatment with curative versus non-curative intent. We identified an existing framework for adult cancer developed in a high-income country (HIC) context and described similar and novel factors relevant to low-and middle-income country settings. We used scoping review methodology to identify and synthesize existing literature on factors influencing decision-making for pediatric and adult cancer in these settings. Articles were identified through an advanced Boolean search across six databases, inclusive of all article types from inception through July 2022. Seventy-nine articles were identified from 22 countries across six regions, primarily reporting the experiences of lower-middle and upper-middle-income countries. Included articles largely represented original research (54%), adult cancer populations (61%), and studied patients as the targeted population (51%). More than a quarter of articles focused exclusively on breast cancer (28%). Approximately 30% described factors that influenced decisions to choose between therapies with curative versus non-curative intent. Of 56 reported factors, 22 novel factors were identified. Socioeconomic status, reimbursement policies/cost of treatment, and treatment and supportive care were the most commonly described factors. This scoping review expanded upon previously described factors that influence cancer treatment decision-making in HICs, broadening knowledge to include perspectives of low- and middle-income countries. While global commonalities exist, certain variables influence treatment choices differently or uniquely in different settings. Treatment regimens should further be tailored to local environments with consideration of contextual factors and accessible resources that often impact decision-making.

Sexism is not about the culture intrinsic to a specific health care system; it is pervasive throughout clinical and academic medicine. Gender equity in medicine won’t materialize until mainstream dialogue is overrun with stories about sexism.

Despite recognition that infertility disproportionately affects women in medicine, and despite the precedent for successful subsidization of medical therapies, few medical professionals have access to affordable treatment for infertility.

Purpose Patient/parent perceptions of poor‐quality prognostic disclosure have not been well described, and these data offer important lessons to shape clinical practice and communication skills training. In this study, we aimed to characterize patient/parent negative experiences with prognostic communication to inform future efforts to improve how clinicians disclose prognosis. Patients and Methods Semistructured interviews were conducted with a purposeful sample of pediatric cancer patients (n = 25) and parents (n = 40) across different timepoints in the progressive illness course extending into bereavement. Interviews were audio‐recorded, transcribed, and de‐identified for rapid qualitative analysis, in which multiple analysts used a standardized episode summary template to extract raw data specific to patient/parent narratives about prognostic disclosure experiences. Analysts engaged independently and collaboratively as a team in reflexive memo writing to identify negative experiences with prognostic communication, followed by team discussion to generate concepts and synthesize those concepts into themes. Results More than half of participants (59%) described negative experiences with prognostic disclosure, with parents highlighting distressing communication experiences more often than patients (parents: 32/40, 80% vs. patients: 6/25, 24%). Across patient/parent narratives, three main themes underpinned the perception of poor‐quality prognostic communication: (1) insufficient information, (2) overwhelming or contradictory information, and (3) absence of person‐centered connection. Conclusion Many patients/parents perceived prognostic disclosure to be suboptimal and identified specific features underpinning poor‐quality prognostic communication. These findings will inform future collaborative research with patients, parents, and multidisciplinary clinicians to codesign an intervention that individualizes prognostication to align with patient/parent preferences for receiving information and fostering connection. Patients with cancer and their families have important lessons to teach oncology clinicians about how to improve care. In this study, we asked pediatric patients and parents to reflect on how their doctors talked about prognosis to help us identify ways to improve this process. We learned that when patients and parents feel that the doctor did not discuss prognosis in a good way, it was usually due to (1) insufficient information, (2) overwhelming or contradictory information, and (3) absence of person‐centered connection. These findings will help guide communication training and future research to improve communication.

Background and Objectives: Little is known about the final week of life for inpatient pediatric oncology patients. The purpose of this study was to describe inpatient pediatric oncology deaths. Methods: Retrospective chart review of all patients who died in a large pediatric cancer center between 2007 and 2017. Demographic, diagnostic, and proximate cause of death information was extracted. Intensive care unit (ICU) admissions, chemotherapy receipt, medical interventions, and cardiopulmonary resuscitation (CPR) events one week, 48 h, and 24 h prior to death were obtained. Analysis included descriptive and statistical correlations. Results: 344 decedent pediatric oncology patients were included. Half of the patients died in the ICU (51%). The average age was 11.3 years (range 0.13–27.7 years). Most had ongoing evidence of disease (86%) with 20% receiving cure-directed chemotherapy during their final week. Receiving cure-directed chemotherapy was not associated with age, race, ethnicity, or diagnosis but was associated with a significantly increased likelihood of receiving CPR on the last day of life (p = 0.011). The majority (84%) of children did not receive CPR on their final day of life. Receipt of CPR was not associated with race/ethnicity. CPR was associated with younger age (p = 0.006), hematologic malignancies (p = 0.037), and ICU location (p < 0.001). Most patients were not on dialysis (84%), pressors (72%), or ventilated (60%) during the final 24 h of life. Compassionate extubation occurred in <6% of deaths. Conclusions: Most deaths in a pediatric cancer center occur in children with active disease. Continuation of cure-directed chemotherapy, age, diagnosis, and location of death has potential to influence end-of-life inpatient care.

Background Bereavement after the death of a child is devastating and associated with worse physical and psychosocial well‐being in parents. Evidence suggests that parents desire and benefit from support provided by other bereaved parents. To foster this peer support, an institutional peer‐to‐peer mentorship program for bereaved parents was established, through which trained bereaved parent mentors offer support for newly bereaved parents. Methods Using a retrospective cohort design, we describe the characteristics of participants of the Bereaved Parent Mentorship program. Trained bereaved parent mentors documented encounters with newly bereaved parent mentees using a secure internet‐based form. Mentors summarized each encounter including any concerns or need for professional psychosocial support. Descriptive statistics were used to describe mentor and mentee characteristics; free text from encounter summaries was qualitatively analyzed using content analysis. Results A total of 1368 documented encounters occurred between 150 mentees and 39 mentors from January 1, 2014 to February 29, 2020. Only seven encounters (0.5%) were flagged as serious concern necessitating professional psychosocial support. Four key themes in the encounters between mentors and mentees emerged, including: descriptions of the grief experience, ways in which a mentor supported their mentee, challenges the mentor experienced in supporting the mentee, and personal benefit gained by the mentor from supporting their mentee. Conclusion This structured Bereaved Parent Mentorship program fostered rich interactions between bereaved parent participants, with very few encounters requiring professional assistance. Future research will assess the impact of bereaved mentor programs on resilience and psychosocial, physical, and functional well‐being of parents. This structured Bereaved Parent Mentorship program for parents whose children died of cancer fostered rich interactions between bereaved parent participants. Very few encounters in this program required professional psychosocial assistance. Future research will assess the impact of bereaved mentor programs on resilience and psychosocial, physical, and functional well‐being of parents.

Background/Objectives: High-quality prognostic communication in pediatric oncology is essential to support informed decision making, foster trust, and honor goals of care. While families differ in their preferences for how prognosis is discussed, clinicians often rely on assumptions rather than directly eliciting these preferences, risking misalignment and distress. To address this gap, we aimed to characterize patient, parent, and oncologist perspectives on key variables, experiences, and circumstances that influence their preferences for prognostic communication. Methods: Semi-structured interviews were conducted with 85 participants (25 patients aged 12–25, 40 parents, and 20 oncologists) to elicit their preferences for prognostic communication and the reasons behind these preferences. Rapid analysis was conducted to generate themes and identify patterns and variances across participant cohorts. Results: Four distinct themes underpinning prognostic communication preferences were described by patients, parents, and oncologists: (1) personality, ideals, and values; (2) general life experiences; (3) prior interactions with the medical system; and (4) faith. Participants emphasized that personal identity and prior experiences significantly shaped how they wished to receive prognostic information. Clinicians and parents often linked preferences to core aspects of their professional or caregiver identities. Conclusions: Understanding the individualized factors shaping communication preferences can guide clinicians in tailoring prognostic discussions. Open-ended inquiry into identity, personal values, and past experiences can foster respectful, personalized communication in pediatric oncology. Further research is needed to determine best practices for prompting discussion about prognostic communication preferences that incorporates the reasons underpinning these preferences.

Palliative Care in Sickle Cell Disease Additional efforts are needed to improve quality of life and mitigate suffering in people with sickle cell disease. The field of palliative care is well positioned to help address this need.