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April 2018

Hope, Optimism, and Compassionate Communication

Author Affiliations
  • 1Division of Hematology and Oncology, Department of Pediatrics, Washington University, St Louis, Missouri
  • 2Division of Critical Care Medicine, Department of Pediatrics, Washington University, St Louis, Missouri
  • 3Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St Louis, Missouri
JAMA Pediatr. 2018;172(4):311-312. doi:10.1001/jamapediatrics.2017.4536

Dr Smith is entering a family meeting for a 5-year-old boy with relapsed leukemia and multisystem organ failure. She intends to encourage transitioning from curative to palliative treatment. A nurse stops her to express concern: “Mom is still hoping for recovery. She feels that we are all against her.” Dr Smith feels conflicted because parental hope for their child’s survival seems appropriate, but she knows this patient will not survive. Dr Smith wonders how she can allow the parents to feel hopeful while still delivering objective evidence of dismal prognosis and providing compassionate end-of-life care.

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