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The conversation based in the future between a boy and father in the visitor

  • This is one reason why such a high proportion of our teaching has been judged good or outstanding by independent reviewers;
  • Last year there were a number of concerns expressed which related to;
  • Thus, if one were to stop there, one might indeed feel that conversations are focused on false hopes;
  • Just over a third of short visits of 28 days or less by Poles to the UK are to visit family and friends;
  • Sports activities were mentioned — could we have more in the curriculum;
  • Minds were set at rest due to their swift response.

Select Examples Parents described several ways of balancing hopes with more difficult expectations. Some described cognitive dissonance: We know, you know, the options of what could happen but we have to for our own sanity remain hopeful.

Some parents expressed wistfulness: I mean, that would be the ultimate. Our findings strongly contradicted this view. Yet they remained hopeful. Many parents acknowledged this apparent contradiction directly: Instead, clinicians focused conversations on treatment and treatment-related side effects. If treatment is the currency of the oncologist-patient relationship, 24 then offering treatment may be a way of continuing to take care of patients and affirming the relationship even as disease progresses.

It is important to recognize that conversations about treatment likely met the preferences of many parents, especially those seeking second opinions. In addition, clinicians may feel that having conversations about hope is a delicate issue.

  1. No conversations were observed directly despite the importance of nonverbal cues.
  2. Whether as workers, grandparents, or aged parents, the future looks very uncertain indeed for older Poles after Brexit. My son receives excellent support above and beyond what I expected at the outset.
  3. Survey evidence from 2007 indicates that two thirds of Poles believe that children, not the state, should care for their parents as they grow older and in need of care. You can talk to any member of staff or any governor direct, via the school office or via the feedback form or governor email on the website.

Many of the clinicians were conscientious about conveying honest information, no matter how difficult. If clinicians view hope as representing false hopes for a cure, they may worry that engaging in discussions about hope can be misleading.

  1. In addition, a survey of staff is conducted each year. If you have any questions, please come along to the Open Forums next week to ask, or you can always direct your questions to the governors via the school offices.
  2. This, together with open days and an open evening, give parents several opportunities to discuss their child. I feel my child has been recognised for their skills and at each parents evening I am given targets and ideas to continue to develop those skills.
  3. Some parents expressed wistfulness.
  4. Previous work supports the idea that parents can understand a difficult prognosis, yet remain hopeful.

Yet we were also struck by the richness of the content of parent interviews. The 2 sets of transcripts clinician-parent discussions and parent interviews were strikingly disconnected in their content. Thus, we wondered whether clinicians might be able to bring the 2 conversations together, giving time to both hope and reality.

  • Leadership and management of the school Three quarters of you agreed that the school is well led and managed;
  • This is one reason why such a high proportion of our teaching has been judged good or outstanding by independent reviewers;
  • Thus, if one were to stop there, one might indeed feel that conversations are focused on false hopes;
  • Many parents acknowledged this apparent contradiction directly:

Previous work supports the idea that parents can understand a difficult prognosis, yet remain hopeful. We used a similar interview technique, and found that parents were able to report hopes for many things, some possible, some impossible.

When first asked about their hopes, most parents initially discussed hopes for treatment outcomes, including cure. Thus, if one were to stop there, one might indeed feel that conversations are focused on false hopes. Yet with additional questioning, hopes arose that were possible: Why ask parents to detail their hopes, when so many will never be?

We would suggest that conversation about hopes, even impossible ones, can be a doorway toward talking about what is possible. Back et al 25 have proposed that physicians can use conversation about hope to help patients prepare for the future.

Possible hopes, as opposed to less likely hopes, may be used to focus plans of care for the child, and to address informational, social, or affective needs, but only if clinicians are willing to engage in these conversations.

To allow parents to fully understand the nature of the study, we sought consent during a delicate window: This timing was clearly stressful, and many parents declined to participate. These conversations were also logistically challenging to capture, and in some situations we were unable to record the relevant discussion.

‘Flying grandmothers’

No conversations were observed directly despite the importance of nonverbal cues. Parents who enrolled may have been those most able to process difficult information about relapse and engage in conversations about hope.

However, all of the enrolled parents were able to hold these conversations, and most distinguished hope from reality, suggesting that many parents would be able to do so in a wider population. In addition, we captured only a single conversation, while discussions likely evolved over time. Also of note, although many children had poor prognoses and have died since study inception, some are alive still, and some potentially cured.

We identified eligible children based on a probable poor prognosis, but could not predict this with certainty. This reflects the clinical reality for many children and parents; uncertainty about the future is common, and these parents, too, must live with the possibility of a difficult future.

Children also were present in many conversations; their presence likely affected the tenor of discussions, particularly about difficult prognoses, even though we did not detect major differences. However, questions about hopes, goals, and values may be appropriate to every conversation, whether children are present or not, and even in the setting of clinical uncertainty.

  • Most people in families get on well most of the time and are very fond of each other;
  • There is little change in the number of respondents since last year, with 142 full responses in 2014;
  • Or catch a governor at a school event.

Finally, although parents could distinguish hope and reality, not every parent was at peace with that distinction. Parents who openly spoke about denial as a way to live through this time exemplified that issue.

Thus, we should remember that a conversation about hope does not mask the pain of this situation; instead, it may unmask it.

Yet parents appear to be experiencing these struggles whether clinicians address them or not. Opening the conversation to hope may be one way for clinicians to join parents, and the children they love, through these times.

Parental Hope for Children With Advanced Cancer

Acknowledgment The authors acknowledge Jane C. Weeks, MD, MSc, who was integral to this work from its inception. Although she did not live to its completion, she made the work, and us, better.

Footnotes Accepted February 23, 2015.

Routes for relatives closing

Address correspondence to Jennifer W. The authors have indicated they have no financial relationships relevant to this article to disclose. The authors have indicated they have no potential conflicts of interest to disclose.