TABLE 1.

Six core functions of clinician–patient/parent communication—adapted from Epstein and Street¹

Function	Description	Example
Fostering healing relationships	Healing relationships provide emotional support, guidance, and understanding. Such relationships are built on trust, rapport, and mutual understanding of each other’s roles and responsibilities. Physicians can facilitate a healing relationship by engaging in active listening, partnership building, seeking out goals and values of the patient and family, displaying warmth and empathy in communication.	In disclosing a new diagnosis of cancer in a child, the physician listens and speaks in an empathic manner that creates a trusting relationship between the physician and the family.
Exchanging information	Patients and their families seek information about the cause, diagnosis, treatment, prognosis, and lasting effects of cancer and its treatment. Fulfilling information needs not only helps families to gain important knowledge about a child’s illness, but also aides the development of a strong clinician–family relationship and supports decision making, among other outcomes.	Prior to enrollment in a clinical trial, the physician describes the risks and benefits of enrollment, as well as the prognosis of the child.
Responding to emotions	Patients with cancer can experience a range of emotions, including fear, sadness, anger, anxiety, and depression. When patients or parents express emotions in clinical encounters, the clinician’s task is to recognize the emotional state, ask questions, communicate understanding, and respond with empathy or tangible help.	After a CT scan demonstrates progression of disease, the child’s nurse reflects the parents emotional state and provides emotional support as they process the information.
Managing uncertainty	Parents and patients experience many types of uncertainty after a diagnosis of cancer. This uncertainty can pertain to prognosis, side effects, frequency of hospitalization, and long-term effects, among others. Family-centered communication should help to communicate clinical uncertainty when it exists, dispel uncertainty when there is an answer, and help patients and families to manage unavoidable uncertainties.	As a child reaches the end of treatment for cancer, the nurse practitioner sets the families expectations for what is normal versus abnormal after completion of therapy.
Making decisions	Effective decision making requires effective communication. Such communication can support decision making in a number of ways: raising the clinician’s awareness of the family’s needs, values, and fears; clarifying clinical reasoning and treatment options; alerting the physician to the family’s preferred role in decision making.	The physician assesses the family’s values and fears, then makes a recommendation regarding whether to pursue fertility preservation for their young daughter with newly diagnosed cancer.
Enabling patient self-management	Communication can also help patients to “enhance their ability to solve health-related problems and to take actions to improve their health.” This can encompass recommendation, instruction, and advocacy.	Prior to a family’s first discharge from the hospital, the physician discusses dangerous warning signs that merit evaluation in the emergency department.