The "Day Zero Talk": the Initial Communication of a Pediatric Oncology Diagnosis by Primary Care Physicians and Other Primary Care Providers.

While much is known about the initial communication of a definitive pediatric cancer diagnosis by the child's pediatric oncologist, little is known about the discussions leading up to this formal conversation, which are often had with nononcologists. We sought to describe these initial conversations regarding the possibility of a child's oncologic diagnosis, from the perspective of both the patient/family as well as the provider. Semistructured interviews were performed with individuals involved with a child with recently diagnosed cancer at a quaternary care institution in an urban, mid-Atlantic city. Interviews were recorded, transcribed, and analyzed using qualitative thematic analysis. In total, 71 people were interviewed, representing the experiences of 29 unique pediatric patients. Patient and caregiver themes included recognition of the urgency of the situation and variety of terms used to indicate the potential of cancer. Physician themes included the impact of health literacy on the discussion and varying opinions on how direct to be regarding the possibility of a cancer diagnosis. The initial discussions of the possibility of a pediatric cancer diagnosis often occur with nononcologists, and this day zero talk is critical in laying the groundwork for future communication with providers.

When my four-year-old got cancer: a retrospective on resilience in a paediatric oncology ward.

The author presents an interpersonal experience between the author and her son during childhood cancer treatment and care, illustrating the complex relationship between childhood cancer and the term 'resilience'. During treatment and care, nurses used the term 'resilience' in an apparent attempt to reassure her. However, the author found that the concept distanced her from her and her son's experience, creating emotional distress for him. She discovered that the everyday use of resilience, devoid of its research connotations, has the potential to create barriers in understanding these experiences for the patient and the caregiver. For example, this everyday use did not account for the relationship that resilience has with growth. It is not just important in terms of diagnosing a tumour, it is also important for supporting the agency of a child and the cultivation of trustworthiness. A focus on growth supports the notion of an "active resilience," a process informed by research literature to help medical staff and families develop the child patient's capability for growing into resilience throughout the survivorship experience. By neglecting this relationship with growth, resilience was found to silence the agency and voice of the author's child which added to the difficulty that she had in providing care. As more children survive cancer, a meaningful use of the term resilience can support their recovery from the adversities of treatment and a life of adverse outcomes. The ethnographic detail provides the context necessary for contributing to and unpacking the normative use of the term resilience in paediatric oncology.