The “Day Zero Talk”: the Initial Communication of a Pediatric Oncology Diagnosis by Primary Care Physicians and Other Primary Care Providers

While much is known about the initial communication of a definitive pediatric cancer diagnosis by the child’s pediatric oncologist, little is known about the discussions leading up to this formal conversation, which are often had with nononcologists. To describe the initial conversations regarding the possibility of a child’s oncologic diagnosis, this study conducted semi-structured interviews with patients, their caregivers and physicians, including primary care practitioners.  Patient and caregiver themes included recognition of the urgency of the situation and variety of terms used to indicate the potential of cancer. Physician themes included the impact of health literacy on the discussion and varying opinions on how direct to be regarding the possibility of a cancer diagnosis. Primary care practitioners in particular felt that, having often known the family for years prior to discussion, they could better interpret what their patients’ families were ready to hear and have a sense of how best to convey that information at an appropriate health literacy level. This study highlighted the role family health literacy plays in understanding of a patient’s diagnosis. In the future, an improved understanding of family preference and the impacts of health literacy may help guide future diagnosis discussions and improve family transition to oncologic care.

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