The Day 100 Talk: Promoting Family Adaptation through Structured Interdisciplinary Conversation During the Early Childhood Cancer Treatment Period
Background/Rationale: In childhood cancer, high-stakes conversations occur in the early days of illness, when distress may interfere with parents’ abilities to ask questions or seek information. Furthermore, current communication practices may promote mutual silence on issues such as emotional coping and cancer-related beliefs. Unmet communication needs may hamper parental adaptation to the “new normal” of caring for a child with cancer. Therefore, we propose the “Day 100 Talk,” (D100) a novel in-depth conversation between the interdisciplinary oncology team (IOT) and family, with two primary goals: to enhance family adaptation, and to enhance IOT understanding of family context, thereby facilitating improvement in critical family outcomes.
Objective: The overall aims are to: A1. Refine and pilot a pragmatic D100 training program including boosters consisting of high-quality exemplar videos that facilitate just-in-time learning, A2. Optimize a 3-part D100 IOT tool (Conversation Guide, preparatory Family Worksheet, and Family Summary Sheet), and A3. Pilot test D100 impact on parent adaptation for effect size estimation to support the design of a future randomized controlled trial. Hypothesis: Parents will report improved illness understanding, therapeutic alliance, and psychological distress post-D100 relative to pre-D100.
Study/Design: Single-arm feasibility trial of D100 among oncology providers, psychosocial clinicians, and parents of children with cancer for <6 months. We will utilize the Kirkpatrick model to evaluate the pragmatic training program (A1). We will demonstrate feasibility through threshold levels of provider participation (n=10; 70%, A1) and D100 completion (n=40; 60%, A2) and appraise candidate parent outcomes through pre- and post-D100 surveys (A3).
Relevance: The novel 3-part D100 IOT tool and pragmatic training program are intended to be scalable nationally, and have high potential to change the communication paradigm in pediatric oncology and reduce the burden of the childhood cancer experience. Importantly, the D100 concept may have broad relevance to other serious childhood illnesses.
Angela Feraco, MD MMSc is an Instructor in Pediatric
Oncology at Dana-Farber Cancer Institute and Boston Children’s Hospital and
conducts research within the Department of Psychosocial Oncology and Palliative
Care at Dana-Farber. She attended medical school at the University of
California, San Francisco, and completed her residency and chief residency in
the Boston Combined Residency Program, followed by fellowship training in
pediatric hematology/oncology at Dana-Farber Cancer Institute and Boston
Children’s Hospital. She received her Master’s of Medical Science in Medical
Education from Harvard Medical School. Angela’s research seeks to alter the
current communication paradigm during the early treatment phase of childhood
cancer, thereby facilitating enhanced family outcomes across the illness