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How to talk to kids about a cancer diagnosis in the family

When relaying the difficult news of a cancer diagnosis to kids, it's important to give them time to process the information, says Elizabeth Farrell, a clinical social worker at the Dana-Farber Cancer Institute.
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When relaying the difficult news of a cancer diagnosis to kids, it's important to give them time to process the information, says Elizabeth Farrell, a clinical social worker at the Dana-Farber Cancer Institute.

In an emotional message to the world, Catherine, Princess of Wales, revealed on Friday that she was undergoing treatment for cancer.

She said it had been a tough couple of months for her family, and that she focused on comforting and communicating with her young children.

"Most importantly, it has taken us time to explain everything to George, Charlotte and Louis in a way that's appropriate to them and to reassure them that I'm going to be OK," she said.

But what does an appropriate and reassuring conversation with children about a cancer diagnosis look like?

Have the conversation early

Elizabeth Farrell, a clinical social worker with the Dana-Farber Cancer Institute, says that a lot of caregivers' first instinct may be to choose not to tell their children, hoping to protect them. But she says that children have a right to know, especially in the early days of a diagnosis when there may be a flurry of activity at home — seeking doctors' counsel, going to a lot of appointments, making many phone calls — and children are very likely sensing a change in the environment.

"The worst thing that can happen is that a kid finds out about their parent's illness from somebody else," she said.

Timing and place

Farrell says parents need to be thoughtful about where and when they plan to have the conversation.

She often encourages people to choose a comfortable space such as at home, "not in a space where kids may not feel like they can react or respond in a way they want to or need to," she said.

Farrell says that a good time to have the conversation may be on a Friday afternoon after school so the kids have the weekend to process the news.

Type of language

Farrell says it is imperative to use the actual words of the diagnosis because kids will be bound to hear them.

"Use the word 'cancer,' " she said, "be really clear — if you're going to get chemotherapy, then it's 'chemotherapy,' 'surgery,' et cetera."

She also says it is important to remind the child that the best information they can receive is from the parents themselves, and not from the Internet — "Saying to kids, 'So, if you are looking it up, please come to me with things that you are finding or things that you are worried about,' " she said.

How to have the conversation

Farrell says parents could begin by telling their kids that they have some news to share, that it is hard news and it's OK to feel however they feel, but they want them to know what is going on.

She suggests saying something along the lines of: You may have noticed that things are a little weird around here recently. I've been gone a lot, I've been in appointments, I'm on the phone more than I normally am and I wanted to tell you why that is.

Go ahead and tell the kids what kind of treatment it will be, she says, whether it's surgery or chemotherapy.

Farrell says that the next most important thing after breaking the news is making sure to let the kids know how the diagnosis will impact them in terms of their daily lives — someone else may now have to take them to school, or the parent might be spending some time away from home. It's also important to make sure the child's life remains as normal as possible in terms of activities and schedule.

Farrell says to then give the child some space to react, to sit back and ask "What questions do you have?," and to ensure them they can come back with any extra questions they may have in the future.

She encouraged parents to say something like: We're going to keep checking in about this and we'll keep updating you as things happen. The most important thing is we're still a family and we are going to continue to be the same family, we just have something hard going on right now.

Getting emotional is OK

Having the talk will get very emotional and there may be tears or fear, but it may benefit a child to see parents have those emotions.

"It's absolutely OK if you look a little scared or you cry," Farrell said. "Kids need to know it's OK to have those feelings, that this is a hard situation."

She suggested saying something like: I'm a little scared about this too. It's OK to be scared and we can be scared together a little bit, and it makes me sad to talk about but I know you're going to be fine.

She says it's important that the child does not feel like they need to take care of the parent, and or feel like they can't show any emotion.

If the diagnosis is terminal cancer

If a child asks, "Are you going to die from this?," Farrell said that the impulse is to say, "Absolutely not!" But this could breach the trust between a parent and their child.

"There's a way to respond that does not incite panic or anxiety, but is also honest," she said.

She said that if a child asks a parent if they will die, a parent may say: That's not what's happening right now. If at any point we need to be worried about that, my doctors will let me know, and we will let you know.

Finally, Farrell says that children should be able to maintain a sense of trust in the parent. They shouldn't feel left out of the loop, or that they are not an important part of this family or not important enough to be told.

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Hadeel Al-Shalchi
Hadeel al-Shalchi is an editor with Weekend Edition. Prior to joining NPR, Al-Shalchi was a Middle East correspondent for the Associated Press and covered the Arab Spring from Tunisia, Bahrain, Egypt, and Libya. In 2012, she joined Reuters as the Libya correspondent where she covered the country post-war and investigated the death of Ambassador Chris Stephens. Al-Shalchi also covered the front lines of Aleppo in 2012. She is fluent in Arabic.