TABLE 1.

Codebook for Communication Functions in Pediatric Oncology

Communication Function	Definition
Building 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. Clinicians can facilitate a healing relationship by engaging in partnership building, eliciting goals and values of the patient and family, and displaying warmth and empathy in communication.
Exchanging information	Parents 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 aids the development of a strong clinician-family relationship and supports decision-making, among other outcomes. Patients and families also have information that they want to share with clinicians, so exchanging information seeks a bidirectional understanding between clinicians and families.
Enabling family self-management	Parents must manage complex medical, logistic, and emotional challenges within their families. Communication that enables parents to address these ongoing challenges can support family self-management.
Providing validation	Many parents doubt their quality as a parent or feel a sense of guilt or shame when their child has cancer. Effective communication can validate the current experiences and concerns of the parent while also reaffirming their role in the treatment of their child.
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 manage unavoidable uncertainties. Parents and patients also identify uncertainties about possible future outcomes and communicate bidirectionally with clinicians to obtain anticipatory guidance for these uncertainties.
Responding to emotions	Parents can experience a range of emotions, including fear, sadness, anger, anxiety, and depression. Effective communication can respond to emotions that are apparent or anticipate emotional responses likely to develop.
Supporting hope	Hope is essential for parents as they live with the terrifying possibility that their child might die or have significant impairments because of cancer or its treatment. Effective communication can bolster a parent’s sense of hope.
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; and alerting the clinician to the family’s preferred role in decision-making. At other times, decisions might be presented by the clinician as strong recommendations.

We define communication functions as processes within communication interactions that achieve important goals for parents.