Do you have any suggestions to aid in delivering heavy news such as a new cancer diagnosis? Would you tell the parent and patient together or talk with the parent first? Will your strategy differ depending on the age of the child?

I am not expert in this subject, and do not have much experience with it.

I would venture that when horrible things happen, some regression is not only normal but probably the best way for children to get the first support they need for a crisis, so a child's dependency on a parent would be a very healthy bridge to beginning to take in all the information and start to cope with a radical change in life circumstances. I can't think of a situation in which I would not talk first with a parent, even if the child is an old teenager. The first shock may put the parent into a degree of upset he can't manage well, and it's unnecessarily upsetting to the child to make him watch his devastated parent try to compose himself. Further, most parents know their kids better than we do, and we need their help figuring out how to proceed with the kids.

Respect for the parents' ideas of what to say becomes a problem when the parent doesn't want the kid to be told, which is really bad if it goes on too long. After the parent has had some time, maybe parent and doctor should talk to the kid together, to be sure they're using the same words and conveying the same ideas. They need each other's support. Developing, and periodically updating a plan with the parent seems to me like the best strategy.

There's a short story by Lorrie Moore called Canonical Babbling/ Ped Onc, or People Like That are the Only People Here which doesn't address this specific question, but I think it gives a flavor of the parents' perspective.

My last general advice in not to worry too much about full understanding in the first conversation. It's a long process, and you'll have lots of chances to refine. Hope is essential to coping. Sorry I can't be more specific. Yours, Harriet McGurk