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Cited by 0Patient-Provider Communication in HealthcareChildhood Cancer Survivors' Quality of LifePalliative and Oncologic Care

Styles of Delivering News About a Child's Cancer and Parents' PTSD Symptoms

Open access
Farchi, Moshe U., Gidron, Yori·2025·Psycho-Oncology
DOI 10.1002/pon.70071PMC PMC13443818
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Abstract

Background: Receiving a child's cancer diagnosis is a highly traumatic experience for parents, often leading to significant psychological distress, including symptoms of Post-Traumatic Stress Disorder (PTSD). The way healthcare professionals deliver this news can affect the severity of parents' reactions. While some research examines communication style's impact on patients, few studies focus on its effects on parents. Aims: This study explores the relationship between the communication style used by oncologists when delivering a child's cancer diagnosis and the subsequent levels of PTSD symptoms, mental resilience, and self-efficacy in parents. Methods: One hundred twenty eight parents of children diagnosed with cancer participated. Data were collected using the Styles of Communicating Questionnaire (SCQ), PTSD Checklist for DSM-V (PCL-5), the Connor-Davidson Resilience Scale (CD-RISK), and the General Self-Efficacy Scale. Correlations and hierarchical multiple regressions were performed to examine the relationship between communication style and psychological outcomes. Results: Parents who perceived the oncologist's communication style as more activating (clear, structured, and action-oriented) reported significantly lower levels of PTSD symptoms and higher levels of resilience and self-efficacy. The perception of empathy played a crucial role, particularly when physicians balanced emotional and cognitive empathy. This balance was linked to better psychological outcomes in parents. Conclusions: The study highlights the critical role of communication style in mitigating the psychological impact of a child's cancer diagnosis on parents. Training healthcare providers to balance cognitive and emotional empathy in communication may reduce PTSD symptoms and enhance resilience and self-efficacy in parents, ultimately improving their psychological well-being during such a challenging time. © 2025 John Wiley & Sons Ltd.

Integrity signals

Registry

Crossref · 10.1002/pon.70071

Cites

20 of 20 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

9 of 16 cited sources checked · 2 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Cognitive communication, which focuses on providing clear, concrete information and future planning, promotes active coping strategies by facilitating better comprehension and task-oriented responses to stressors.

    “Cognitive communication, which focuses on providing clear, concrete information and future planning, has been demonstrated to promote active coping strategies, as it facilitates better comprehension and task-oriented responses to stressors [10].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [10] 10. F. Derksen, J. Bensing, and A. Lagro-Janssen, "Effectiveness of Empathy in General Practice: A Systematic Review," British Journal of General Practice 63, no. 606 (2013): e76-e84, https://doi.org/10.3399/ bjgp13X660814. source

      The Introduction describes a cognitive component of empathic behaviour, and the Discussion links patient–provider communication with patient comprehension. Neither passage describes cognitive communication as providing clear information and future planning, or demonstrates that it promotes active coping and task-oriented responses to stressors. Page numbers are unavailable in our copy. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • Premisecitation

    Mothers are at greater risk of PTSD following their child's cancer diagnosis.

    “These findings confirm that mothers are at greater risk of PTSD following their child's cancer diagnosis.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [1] 1. A. M. Patiño-Fernández, A. L. Pai, M. Alderfer, W. T. Hwang, A. Reilly, and A. E. Kazak, "Acute Stress in Parents of Children Newly Diagnosed With Cancer," Pediatric Blood and Cancer 50, no. 2 (2008): 289-292, https://doi.org/10.1002/pbc.21262. source

      The Results report that 51% of mothers and 40% of fathers met criteria for acute stress disorder shortly after their child’s diagnosis. That supports a higher observed rate of acute stress disorder in mothers, but the study did not establish that mothers were at greater risk of later PTSD. (LLM, conf=0.89)

      Experimental — accuracy not yet measured
    • cites [2] 2. M. J. Dunn, E. M. Rodriguez, A. S. Barnwell, et al., "Posttraumatic Stress Symptoms in Parents of Children With Cancer Within Six Months of Diagnosis," Health Psychology 31, no. 2 (2012): 176-185, https://doi. org/10.1037/a0025545. source

      The Results (Mothers’ and Fathers’ Elevated PTSS; page unavailable) report elevated posttraumatic stress symptoms in 41% of mothers and 30% of fathers. But the Results (Mean Levels of Mothers’ and Fathers’ Psychological Symptoms; page unavailable) found no significant difference in symptoms between mothers and fathers from the same families. The paper measures symptoms rather than establishing that mothers are at greater risk of PTSD. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation

    Emotional empathy can sometimes intensify distress if it is not accompanied by clear, actionable information.

    “Emotional empathy, which involves expressing compassion and understanding, can sometimes intensify distress if it is not accompanied by clear, actionable information [12].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [12] 12. S. Lelorain, L. Gehenne, V. Christophe, and C. Duprez, "The As- sociation of Physician Empathy With Cancer Patient Outcomes: A Meta- analysis," Psycho-Oncology 32, no. 4 (2023): 506-515, https://doi.org/10. 1002/pon.6108. source

      The Introduction (p. 2) reports that unusually high empathy may increase patients’ worry, and the Discussion (p. 8) suggests that too much emotional empathy can convey hopelessness in bad-news consultations. The Discussion also notes that patients sometimes need medical information rather than an immediate response to their emotions. It does not establish that distress increases specifically when emotional empathy is unaccompanied by clear, actionable information. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
  • Premisecitation

    Mental resilience plays an important role in PTSD.

    “Finally, given the important role of mental resilience in PTSD [14], we also assessed mental resilience and self-efficacy, to validate the new scale of delivery style and to gain insight into the correlates of delivery style.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [14] 14. C. Mikutta, J. J. Schmid, and U. Ehlert, "Resilience and Post-trau- matic Stress Disorder in the Swiss Alpine Rescue Association," Frontiers in Psychiatry 13 (2022): Article 341, https://doi.org/10.3389/fpsyt.2022. 8341. source
  • Findingown data

    The negative correlation between activating announcement and PTSD remained statistically significant after controlling for parents' education and the year the announcement was given (partial r = -0.23, p < 0.05).

    “This negative correlation remained statistically significant also after statistically controlling for parents' education and the year the announcement was given (partial r = -0.23,p < 0.05).”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 8
  • May combine two claims. 8

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In the full sample, doctors' empathy did not predict patients' survival.

    “In the full sample, doctors' empathy did not predict patients' survival.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] 12. S. Lelorain, L. Gehenne, V. Christophe, and C. Duprez, "The As- sociation of Physician Empathy With Cancer Patient Outcomes: A Meta- analysis," Psycho-Oncology 32, no. 4 (2023): 506-515, https://doi.org/10. 1002/pon.6108. source

      Appendix B (p. 18) identifies an included study of overall patient survival, and Appendix D (p. 45) reports a survival association specifically during bad-news consultations. Neither passage states whether physician empathy predicted survival in that study’s full sample; the meta-analysis’s overall result concerns patient outcomes collectively, not survival specifically. (LLM, conf=0.73)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The unexpected finding that highly empathic doctors had higher patient mortality among those receiving bad news stemmed from the emotional empathy items of the questionnaire, while the more activating empathy items were unrelated to risk of death.

    “A deeper inspection of the empathy scale revealed that this unexpected finding stemmed from the emotional empathy items of the questionnaire (e.g., showing compassion), while the more activating empathy items (e.g., making a plan of action) were unrelated to risk of death [12].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] 12. S. Lelorain, L. Gehenne, V. Christophe, and C. Duprez, "The As- sociation of Physician Empathy With Cancer Patient Outcomes: A Meta- analysis," Psycho-Oncology 32, no. 4 (2023): 506-515, https://doi.org/10. 1002/pon.6108. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Among patients receiving bad news, those with a highly empathic doctor were at higher risk of death than those with a moderately empathic doctor, but this did not occur among patients not receiving bad news.

    “However, among patients receiving bad news, those with a highly empathic doctor were at higher risk of death than those with a moderately empathic doctor.This did not occur among patients not receiving bad news [12].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] 12. S. Lelorain, L. Gehenne, V. Christophe, and C. Duprez, "The As- sociation of Physician Empathy With Cancer Patient Outcomes: A Meta- analysis," Psycho-Oncology 32, no. 4 (2023): 506-515, https://doi.org/10. 1002/pon.6108. source

      The appendix table (p. 45) reports that greater empathy predicted a higher risk of death in bad-news consultations and notes an interaction with consultation type. The Discussion (p. 8) also reports a higher death risk associated with emotional and relational empathy in that setting. The available passages do not establish the specific comparison of highly versus moderately empathic doctors or state that the association was absent among patients not receiving bad news. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Cognitive empathy, which integrates understanding with practical guidance, is more effective in reducing anxiety and improving psychological outcomes.

    “In contrast, cognitive empathy, which integrates understanding with practical guidance, has been found to be more effective in reducing anxiety and improving psychological outcomes [20,21].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [20] 20. X. Gao and H. Liu, "The Association Between Cognitive Empathy and Anxiety: The Moderating Role of Cognitive Reappraisal," Acta Psychology Sinica 54, no. 12 (2023): 1455, https://doi.org/10.3724/SP.J. 1041.2023.00892.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [21] 21. R. Smith and S. L. Koole, "Cognitive Empathy and Emotion Regu- lation: Implications for Anxiety and Mental Health," Affective Science 2, no. 3 (2021): 232-245, https://doi.org/10.1007/s42761-021-00062-w. source

      The Discussion reports that greater cognitive empathy was associated with improved emotion regulation relative to affective empathy, but explicitly cautions against a causal interpretation. The paper does not report that cognitive empathy provides practical guidance or is more effective at reducing anxiety and improving psychological outcomes; a search for anxiety-related outcomes found no such result in the paper’s text. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    No associations were found between parents' gender, child's gender, parent's occupational status, parents' marital status, number of children at home, year of diagnosis, child's age and child's treatment phase with parental PTSS (all ps < 0.05).

    “Examining the relationship between each background variable and parents' PTSD symptoms revealed no associations between parents' gender, child's gender, parent's occupational status, parents' marital status, number of children at home, year of diagnosis, child's age and child's treatment phase with parental PTSS (all ps < 0.05).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Cognitive communication can help regulate the amygdala's emotional response, thereby reducing stress and enabling individuals to process difficult information more effectively.

    “Taylor et al. [22] demonstrated that cognitive communication can help regulate the amygdala's emotional response, thereby reducing stress and enabling individuals to process difficult information more effectively.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] 22. S. E. Taylor, L. J. Burklund, N. I. Eisenberger, B. J. Lehman, C. J. Hilmert, and M. D. Lieberman, "Neural Bases of Moderation of Cortisol Stress Responses by Psychosocial Resources," Journal of Personality and Social Psychology 95, no. 1 (2008): 197. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The General Self-efficacy Scale had high internal reliability in the present study (Cronbach's alpha = 0.86).

    “Internal reliability of the questionnaire in this study was high (Cronbach's alpha = 0.86).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The sample primarily consisted of mothers (88.3%), which may limit the generalizability of the findings to fathers or other caregivers.

    “Additionally, the sample primarily consisted of mothers (88.3%), which may limit the generalizability of the findings to fathers or other caregivers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Reliance on self-reported data may introduce response bias, as participants' recollections of communication styles could be influenced by their emotional state.

    “Second, the reliance on self-reported data may introduce response bias, as participants' recollections of communication styles could be influenced by their emotional state.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Initial evidence shows that the Six Cs method was related to less anxiety.

    “Initial evidences shows that the Six Cs method was related to less anxiety [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] 13. M. U. Farchi, L. Bathish, N. Hayut, S. Alexander, and Y. Gidron, "Effects of a Psychological First Aid (PFA) Based on the SIX Cs Model on Acute Stress Responses in a Simulated Emergency," Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publi- cation (2024), https://doi.org/10.1037/tra0001724. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The SCQ was specifically developed for the present study and more research is needed to validate and standardize it.

    “Finally, the SCQ was specifically developed for the present study and more research is needed to validate and standardize it.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The study provides insights into the relationship between the communication style employed by oncologists when delivering a child's cancer diagnosis and the psychological outcomes experienced by parents, underscoring the importance of an activating communication style in mitigating parents' PTSD symptoms and enhancing their resilience and self-efficacy.

    “Specifically, it underscores the importance of an activating communication stylecharacterized by clarity, structured information, future planning, and a balanced approach to empathy-in mitigating parents' PTSD symptoms and enhancing their resilience and selfefficacy.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Parents' recollections of the communication style accurately reflect the actual communication style used by oncologists.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The SCQ was evaluated for comprehension by 8 parents who did not take part in the present study.

    “The questionnaire was evaluated for comprehension by 8 parents (who did not take part in the present study).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Parents of more recently diagnosed children had higher PTSD symptoms than parents of children with more distant diagnoses.

    “Indeed, one study found that parents of more recently diagnosed children had higher PTSD symptoms than parents of children with more distant diagnoses [6].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] 6. S. Phipps, A. Long, V. W. Willard, et al., "Parents of Children With Cancer: At-Risk or Resilient?," Journal of Pediatric Psychology 40, no. 9 (2015): 914-925, https://doi.org/10.1093/jpepsy/jsv047. source
14 of 14

  • The paper relies on this without support.

    The relationship between the style in which oncologists break bad news to parents about their child's cancer and its impact on parents' mental health has not been investigated.

    “However, the analysis of the style in which oncologists break bad news to parents about their child's cancer, and its impact on parents' mental health, has not been investigated, to the best of our knowledge.”

  • The paper relies on this without support.

    Parents' recollections of the communication style accurately reflect the actual communication style used by oncologists.

    “Second, the reliance on self-reported data may introduce response bias, as participants' recollections of communication styles could be influenced by their emotional state.”
2 of 2

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • ConsistentF(4, 101) = 26.8reported p < .001 · recomputed p < .001

    “F (4,101) = 26.8,p < .001”

1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Comprehension measure concerns the parent, not the child

    Minor

    The results identify verification of the child's comprehension as a predictor of perceived staff empathy, whereas the corresponding questionnaire item asks whether the physician ensured the parent understood.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. 10.3389/fpsyt.2022.8341 · DOI
  2. Weathers F. W., 1993, Paper Presented at the 9th Annual Conference of the International Society for Traumatic Stress Studies, San Antonio, TX
  3. Schwarzer R., 1995, Measures in Health Psychology: A User’s Portfolio. Causal and Control Beliefs, 35

Related

Authors
Farchi, M. U., & Gidron, Y.
Affiliations
  • Department of Social Work Research Center for Innovation in Social Work, Tel‐Hai College Upper Galilee Galilee Israel
  • University of Haifa (IL)
Corresponding author
  • Farchi, Moshe U.
  • Gidron, Yori
ORCID
Venue
Psycho-Oncology
Publisher
Wiley
Published
2025-01
Volume
34
Issue
1
Pages
S402-S402
ISSN
  • 1057-9249 (ISSN-L)
  • 1099-1611
DOI
10.1002/pon.70071
PMC
PMC13443818
OpenAlex
W4406231389
Cited by
0
References
19
FWCI
0.00
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 8 d)
Locations
  • Psycho-Oncology (publishedVersion)
  • European Psychiatry (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by)
Topics
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
Keywords
physician-patient communication, news delivery, childhood cancer, parents of children with cancer, post-traumatic stress disorder, psychological resilience, self-efficacy, empathy, affective empathy, cognitive empathy, oncologists
MeSH terms
Oncologists, Adolescent, Adult, Child, Child, Preschool, Communication, Empathy, Female, Humans, Male, Middle Aged, Neoplasms, Parents, Surveys and Questionnaires, Stress Disorders, Post-Traumatic, Self Efficacy, Resilience, Psychological

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