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May 2013

Tackling Taboo Topics: How to Have Effective Advanced Care Planning Discussions With Adolescents and Young Adults With Cancer

Author Affiliations

Author Affiliations: Department of Medical Ethics, Pediatric Advanced Care Team, The Children's Hospital of Philadelphia, and Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania (Drs Walter and Feudtner); Division of Pediatric Hematology/Oncology, Seattle Children's Hospital, and Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington (Dr Rosenberg).

JAMA Pediatr. 2013;167(5):489-490. doi:10.1001/jamapediatrics.2013.1323

How can we clinicians talk about important but scary topics with patients and their parents? More specifically, for adolescents and young adults with cancer, how can we best engage them in advanced care planning (ACP) in a timely manner, especially in light of the reluctance by patients, families, and clinicians to open up this conversation?1 These are important questions: if the disease advances and the adolescent or young adult patient is no longer able to participate in decision making, then the parents or other family members will be called on for guidance regarding the medical choices the patient would have made, providing a so-called substituted judgment on behalf of the patient. Yet, frequently parents and family members do not know in sufficient detail what the patient would have wanted.2 Discussions that would have clarified these issues are often avoided or postponed because they are often felt to be too scary, depressing, or daunting. Indeed, getting patients and families to have these conversations has been a major hurdle since ACP was first advocated more than 20 years ago.3 So what to do?

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