Clinicians often don’t recognize parent challenges in therapeutic relationships
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Many parents of children with cancer experienced challenges in the therapeutic relationship with their child’s treating oncologist, according to study results published in JAMA Network Open.
Researchers additionally found that parent and clinician perspectives often differed. Consequently, clinicians frequently did not recognize the challenges parents experienced.
“We also found that some parents had an especially high risk for challenges, including parents of Asian or other race and ethnicity, and parents of lower education,” Jennifer W. Mack, MD, MPH, researcher in the department of pediatric oncology at Dana-Farber Cancer Institute, told Healio. “We saw similar trends for Black and Hispanic patients, but without meeting statistical significance. Still, this work suggests that some parents are especially likely to be underserved, and their perspectives are often not recognized.”
Rationale
Relationships between patients and family members and clinicians can be difficult, according to Mack.
“Even well-intentioned clinicians who work hard to make things go well run into these challenges,” she said. “Nonetheless, these issues have not been well-characterized in past research, which means we have little research to guide us in improving relationships and navigating them successfully. This struck me as an important need to improve care for all children and families.”
Methodology
Mack and colleagues conducted a survey among 400 parents (74.5% women; 55.8% white) of children with cancer and 80 clinicians (71.3% women; 47.5% attending physicians) to identify the prevalence of challenging parent-clinician relationships in pediatric oncology and factors associated with these challenges. At least three previous clinical visits occurred between parents and clinicians.
Key findings
Of the 338 relationships with paired parent and clinician surveys, clinicians considered 37.6% challenging, parents considered 24% challenging, and both parents and clinicians considered 9.8% challenging.
Compared with white parents, parents of Asian or other race or ethnicity more likely reported challenging relationships with clinicians (OR = 3.62; 95% CI, 1.59-8.26), as did those who had lower educational attainment (OR = 3.03; 95% CI, 1.56-5.9).
Among the 127 relationships in which clinicians perceived challenges, they used a variety of strategies more frequently compared with 211 relationships in which they did not perceive challenges, including holding regular family meetings (17.3% vs. 6.2%; P = .009) and offering more time and attention (52% vs. 28.4%; P < .001).
“Although we found that clinicians used a number of strategies to improve relationships, they generally used these in relationships they themselves considered challenging — not in relationships parents considered challenging,” Mack said.
Implications
New strategies are needed to improve experiences for parents and help clinicians recognize parents whose experiences are suboptimal, Mack said.
“Only with increased awareness can clinicians improve care for all families,” she added. “Future research should focus on ways to more proactively meet the needs of families who experience challenges in the therapeutic relationship. Because many clinicians are not even aware of parental dissatisfaction, interventions are also needed to help clinicians identify families dissatisfied with care.”
For more information:
Jennifer W. Mack, MD, MPH, can be reached at Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215; email: jennifer_mack@dfci.harvard.edu.
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