Table 2.

Suggestions to Alleviate Distress and Minimize Conflict

Issue to Consider	When to Consider the Issue	Conversations That May Minimize Conflict	Why The Conversation May Minimize Conflict
A family coming from another country may not be familiar with Western practices	During discussion with referring team (prior to a transfer of care)	Simple but clear descriptions of how your system works (eg, “Our hospital is a teaching hospital and carefully supervised students will be part of your care team.”).	Some aspects of Western care may feel frightening and unfamiliar to new families; providing an opportunity to explain the systems and safeguards may avoid later confusion and discomfort.
		Disclosure of norms (eg, “When we take care of adolescents, we try hard to understand their needs, as well as those of their whole family. This often means that we talk directly to the adolescent himself or herself.”).	Advanced discussion and explanation of Western practices and values opens the door to mutual sharing and explorations of family needs. This process may also avoid later misunderstandings, including heightened patient and family anxiety that is often associated with nondisclosure.
A family prefers that prognostic information be withheld from an adolescent patient	During early conversations with the family	Exploration of cultural values and prior experiences, rationale for family’s request (eg, “I can see how much you want to protect your daughter. What do you think might happen if we talked to her directly?”).	Exploring shared values of the child’s best interests may help align parents and HCPs, plus open doors to conversations about possible positive consequences of truth telling including alleviating the child’s fears and understanding the child’s wishes.
		Exploration of what to do if the adolescent asks directly about her prognosis or disease status (eg, “It is important that [patient] know she can trust me, so I would like to answer honestly if she asks me.”).	Advanced discussion about “what ifs” can prevent staff anxiety about courses of action and help prepare for contingencies.
	When the child’s disease worsens	Sharing prior experiences, either from the medical team’s perspective or by enlisting a trusted member of the community who is familiar with Western hospitals and practices (eg, “Would it be helpful to talk about how other families have navigated this difficult situation?”).	Normalizing the difficulty and providing perspectives of other members of the cultural community may alleviate feelings of isolation and provide some acceptable options to families.
		Sharing common pitfalls resulting from nondisclosure, including inconsistent messaging from multiple HCPs, child hearing inadvertent news from staff or other patients, child taking cue from parents not to talk about a taboo topic despite internal needs to do so, child drawing incorrect conclusions from social media or internet (eg, “Would it be okay if I share with you some of the possible problems that sometimes arise in these situations?”).	Anticipating issues may facilitate conversation and, ultimately, disclosure on parents’ own terms and in a safe/controlled setting.
		Ongoing involvement of the initial and trusted care team via periodic telecommunication or in-person visits.	This may serve dual roles: (1) to assure that all HCPs are on the same page and (2) to reinforce the current approach to the patient/family.

Abbreviation: HCPs, health care professionals.