Finding the Words: Talking Cancer with Children

Podcast Transcript

Speaker 1:

Welcome to Little Health, a Cleveland Clinic Children's Podcast that helps navigate the complexities of child health one chapter at a time.

In each session, we'll explore a specific area of pediatric care and feature a new host with specialized expertise. We'll address parental concerns, answer questions, and offer guidance on raising healthy, happy children. Now, here's today's host.

Dr. Seth Rotz:

Welcome back to Little Health. I'm your host, Dr. Seth Rotz, a pediatric hematologist oncologist at Cleveland Clinic Children's. As a physician, I know how challenging it can be to have difficult conversations with children, especially when facing a serious diagnosis like cancer. On today's episode, our guest is Dr. Kate Eshelman, my colleague, a pediatric psychologist at Cleveland Clinic Children's. Welcome to Little Health, Dr. Eshelman.

Dr. Kate Eshelman:

Thank you so much for having me.

Dr. Seth Rotz:

Can you, um, tell our listeners a little bit about yourself, how you got into this profession, what you spend your day-to-day time doing?

Dr. Kate Eshelman:

Sure. I am a pediatric psychologist, which means I work with children and their families that have acute and chronic health conditions. Um, so I am the psychologist for our peds hemoc department. Um, and anytime we have a new oncology diagnosis, or someone that is new to us, meaning, they've been treated somewhere else and are seeking care here, pediatric psychology is a routine consult. So we work with these families, um, in the outpatient setting and the infusion setting and in the hospital. and really can kind of meet them where they are and follow them every step of the way.

Dr. Seth Rotz:

You know, one of the things that we thought people might want to hear about is when and how to break difficult news to, to kids. In your role, when do you tend to get involved in these conversations, and how do you think about approaching them?

Dr. Kate Eshelman:

Sure. Especially if a child is admitted to the hospital at the time of new diagnosis, there's a lot of people coming in and out of the room, um, throughout that early admission.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

So we really try and keep an eye on what's going on in the patient's day-to-day and come in when it makes the most sense. But really, the sooner the better. And we are part of a multidisciplinary team that can do some of this work, but really the sooner the better.

Dr. Seth Rotz:

Yeah. When you have those conversations with, with parents and families, how do you see your role versus maybe the physician's role? And then, when you're having conversations with children, how, how do you tailor conversations to different age groups and stuff?

Dr. Kate Eshelman:

Sure. So I think to your first point, how our role differs from the physicians. Oftentimes, the physician or a member of the medical team is going over the specific medical information, the specifics of the treatment plan. Um, certainly, we can be there to, to support that conversation, um, but oftentimes come in after to talk with parents about sharing this information in a developmentally appropriate way. And I think that that's a real key here, because certainly, we have kids of all ages from infants, you know, to young adults that are diagnosed. And so the way that we communicate with those people is gonna differ based on their-

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

... age.

Dr. Seth Rotz :

Yeah. You know, one of the things we'll hear sometimes from parents is, "How do I tell my, my child about this?" And, you know, some- sometimes parents will wanna tell children, sometimes they prefer the medical treatment tells children a little bit about what's going on. How do you navigate those discussions? Like, who do you think is best? Or, or does it depend?

Dr. Kate Eshelman:

I think it depends. You know, I think a lot of that is based on parent preference. You know, their comfort in, in communicating the information. So if they want the team to do it, if they want, you know, somebody from the team to support them in doing it. But really, kind of measuring their comfort level and knowing that they know their children and trusting kind of their goals for that.

Dr. Seth Rotz:

When you are part of those conversations and there, there's tough questions being asked, how do you deal with that as a, as a professional? Like, what do you take into those conversations? How do you prepare yourself for those conversations?

Dr. Kate Eshelman:

Well, I think what's important as the professional to be prepared is knowing the information.

Dr. Seth Rotz:

Yeah. Yeah.

Dr. Kate Eshelman:

You know, we've been doing this a long time now. Um, so, so feeling pretty comfortable with, with the medical information and being able to communicate that, um, and then getting insight from the family about how their child responds best in the best approach to their child.

Dr. Seth Rotz:

Yeah. So it's really an indi- individualized type, um, discussion.

Dr. Kate Eshelman:

Very much so.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

Yeah.

Dr. Seth Rotz:

A lot of times, parents will come to us with questions about why. "Why this happened?" And in childhood cancer in particular, you know, about 1 in 10 cases of childhood cancers from, like, a germline predisposition syndrome, meaning something that was passed on in, in the family line that maybe made the child more susceptible to cancer. And at the same time, that means 90% of these cases are gonna be kind of sporadic with no real answer why things happened. When parents ask, why did this happen, and there's no specific reason that you can give them, how, how do you approach that type of question?

Dr. Kate Eshelman:

I think it's very hard because, um, you know, the, the answer I don't know, or we don't know, is not very satisfying.

Dr. Seth Rotz:

No, it's not, yeah.

Dr. Kate Eshelman:

And sometimes it's the truth-

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

... right?

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

So if, I think if kids or parents have questions, you know, if there are answers to those questions, the first goal is to figure out a plan to get the answer right?

Dr. Seth Rotz:

Mm-hmm.

Dr. Kate Eshelman:

So especially if we're supporting a child, you know, do we look stuff up on the internet? Do we make a list of questions to take back to the medical team, um, to try and seek answers if they exist? And if they don't exist, being comfortable, I think, for the providers and the parents to say, "We don't know."

Dr. Seth Rotz:

Yeah. Yeah. That's an interesting question. You know, like, um, the, the lens that I view these conversations in is similar but not exactly the same as yours. And, and some of the, the information I cover, like, it's like a Venn diagram. I mean, some of this stuff overlaps. What are those questions that you often get? What should I be aware of that families might wanna hear that I'm not telling them?

Dr. Kate Eshelman:

You know, to be honest, I think a lot of times, especially upfront, the families are so overwhelmed with information, they don't know what to ask.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

And so, sometimes it's being able to provide that guidance, you know, giving them information we think they'll want or need without them actually articulating that. Um, I think for all of us to feel most comfortable, it's helpful to know what to expect, and kind of focusing on the immediate next steps as opposed to the, the long-term picture. So if we're talking to a child that's either the patient or a sibling, you know, talking to them about, "Okay, we're gonna go to clinic, we're gonna expect that we're gonna go there and come home that day."

Dr. Seth Rotz:

Mm-hmm.

Dr. Kate Eshelman:

"These are the things that we think will happen while we're there." You know, I think giving that anticipatory guidance can be very helpful. But I think a lot of questions parents wanna know or information they wanna have is, is my child gonna be okay?

Dr. Seth Rotz:

Yeah. Yeah.

Dr. Kate Eshelman:

Um, you know, I think survival is the, the first piece of that. And then thrive, right? Are they gonna-

Dr. Seth Rotz:

Yeah. Thrival.

Dr. Kate Eshelman:

I don't made that up.

Dr. Seth Rotz:

I like it. I like it.

Dr. Kate Eshelman:

But, you know, are they gonna, can they still go to school? Like, are they gonna pass this grade? Are they still gonna have friends? Can they still participate in dance? You know, it's those questions, um, again, for their diagnosed child, but for siblings as well.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

Kind of what is this life gonna look like?

Dr. Seth Rotz:

Yeah. That's an interesting topic you bring up there about, about siblings, uh, other kids or other care providers in the household, people that are intimately part of people's lives. So, you know, I might have a conversation with a patient and family, but the, the family might want to talk to you about how to talk to an- another child. What's that like, uh, in terms of connecting with siblings and helping parents to talk to siblings, maybe not just with a child with cancer, but any complicated diagnosis. What's that like?

Dr. Kate Eshelman:

Yeah, and I think it that it, the same applies to both the, the diagnosed patient and the siblings or other children in their life, or adults for that matter. But the goal is really always to tell the truth in a developmentally appropriate way.

Dr. Seth Rotz:

Mm-hmm.

Dr. Kate Eshelman:

So we wanna tell them what's going on. We wanna use factual language as much as possible, I think, in particular, for siblings. You know, we wanna name the diagnosis. This child has cancer, she has leukemia, which is a type of blood cancer, you know, rather than saying she's sick. Um, we wanna avoid fear, um, of, of, or undue fear. You know, I think that everybody gets a little on edge going forward, but then kids might think forever, well, if I get sick, does that mean I have to go to the hospital or I have to have chemotherapy?

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

So using very specific language, um, and, and telling the truth in a developmentally appropriate way is very helpful. Um, I think it's important to note that, um, we have supports in place not only for the child, but for the family members as well. So for example, here at Cleveland Clinic Children's, we do have our Sibling Outreach program, which is focused both, um, on kind of psychoeducation, um, therapeutic interventions and then social interventions as well. Um, trying to promote social interventions between the, the well child and the diagnosed sibling.

Dr. Seth Rotz:

Mm-hmm.

Dr. Kate Eshelman:

But then other, um, families that have the diagnosis in the family so that there are supports in place for all family members.

Dr. Seth Rotz:

Yeah. Can you, can you talk a little bit more about some of those resources and, you know, how they work and how you make connections for families and?

Dr. Kate Eshelman:

Yeah. Um, so I think, you know, whether they, they, like it or not, once a child is diagnosed, you know, the family's really kind of automatically enrolled in all of the services that we have.

Dr. Seth Rotz:

Mm-hmm.

Dr. Kate Eshelman:

And so while they could be meeting with me individually throughout treatment or a member of my team, you know, those same connections extend to the child. Um, so if the sibling needs individual treatment, that's an option. Um, you know, a couple of times a year, we hold activities, um, for these, these kids and their families. And then we also have a twice a yearly newsletter that comes out that's full of information and resources, things like camps that are available to the patients and their families.

Dr. Seth Rotz:

Mm-hmm.

Dr. Kate Eshelman:

Um, books that are recommended. So, so they're kind of automatically enrolled. They can always reach out. And, and an easy way to communicate with the psychosocial team, um, is through actually our, our amazing nurse care coordinators, um, who often have the most contact with families.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

They let them know they have a need and, and those are communicated to us and we reach right back out.

Dr. Seth Rotz:

Got it. Turning back a little bit, so when you're in a situation with a child that's been newly diagnosed with cancer, what do you tell families about managing emotions, whether it's parents' emotions or the child's emotions? What are those conversations like?

Dr. Kate Eshelman:

Yeah. So I think what we hear from parents is they really identify this need to stay strong, um, whether that's strong for their child or strong for their partner. And what we often talk with them about is that you can stay strong and have emotions, right?

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

It's appropriate to have emotions when something emotional happens. And certainly, a diagnosis of cancer, regardless of what the prognosis or the outcome in is, is disruptive to your life.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

And it's appropriate to have emotions. And so, I think what I talk with parents about is that it's okay for them to express those emotions. You know, what that does is it allows them to show the children that they have emotions, um, you know, and that it's okay to express those emotions. And then it also creates an opportunity, ideally, for the parent to, to cope well with those emotions, which then they can then model that effective coping to the children.

Dr. Seth Rotz:

What would be like an example of, of modeling, of effective coping?

Dr. Kate Eshelman:

I think, you know, if you see a parent who's crying and, you know, she can express, mom can express, you know, "I'm crying because I'm sad that you're in the hospital."

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

"And that you have to go through this. Um, and while I'm feeling sad, I'm also feeling hopeful, um, you know, that, that we can beat this and, and come out stronger, and we're gonna trust these team members to do that."

Dr. Seth Rotz:

Yeah, that makes sense. Yeah, I think, you know, sometimes when we talk to families who are, you know, maybe don't have as much history or background dealing with mental health provider, you know, they think we're trying to cure emotions or, or make them go away and, and that's not it at all. It, it is, I think, as, as you touched on, it's managing these emotions in a, in a healthy and and productive way.

Dr. Kate Eshelman:

Absolutely. I think that's important for the team members to know as well.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

You know, I think, um, adults often get distressed when they see kids expressing emotion. Um, but again, it's appropriate for the child to be distressed, right? Whether they're feeling sad, or scared, or angry, all of those emotions are not unexpected-

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

... in this situation that's unexpected. And, and I think to your point, our goal is, is not to try and decrease the expression of those emotions. Sometimes it's actually just to, to validate and normalize-

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

... them, that, yeah. I would feel pretty angry too.

Dr. Seth Rotz:

Yeah. This is really tough.

Dr. Kate Eshelman:

This is bad. This stinks. Yeah.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

And so just to validate that for them-

Dr. Seth Rotz:

Mm-hmm.

Dr. Kate Eshelman:

... as well.

Dr. Seth Rotz:

Is there a difference in how you might approach patients and families in the inpatient versus outpatient setting?

Dr. Kate Eshelman:

I don't think so. Um, not so much, you know, I think in the inpatient setting, it's much more acute. There's a lot more going on.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

We have to kind of be mindful of, you know, that if a... And, and actually, though, this happens in the outpatient setting as well. I might be the third or fourth provider to come in the room in that moment. And so maybe it's just not a good time.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

And actually, I think that that's very helpful in both settings, but in particular of inpatient, when there's such a loss of control, um, you know, I can come in and say, "Is it a good time?" And they have the ability to say no.

Dr. Seth Rotz:

Mm-hmm.

Dr. Kate Eshelman:

Which is a choice that they can make in a setting when there's not always a lot of choices.

Dr. Seth Rotz:

Yeah. And, you know, we've touched on, like, a lot about a new cancer diagnosis, but there's a lot of stuff that goes on after that. So there's treatment and dealing with the side effects that come with it. You know, one of the things that I clinically focus on is survivorship. And for a lot of our survivors, they may be cured of their cancer, but there's, there's some loss afterwards, right? Like, uh, whether that's, you know, missing a year or two of school or some type of functional limitation, um, or a chronic medical issue that comes with that.

What are those conversations like with you when you're talking to somebody that, you know, isn't dealing with cancer or cancer relapse, but is dealing with some downstream consequence of that?

Dr. Kate Eshelman:

Absolutely. I think we talk a lot actually about grief-

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

... um, and bereavement. You know, I think that that's oftentimes associated with death, and is certainly applicable there. But really, we're, we're grieving the loss of all these important things you just identified. And so, part of that is, are there ways to try and kind of, not, not necessarily replace, but replicate some of these events? And while that may be helpful, we also have to acknowledge that it's, it's... You can't replace it, right?

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

It's still a loss. So we can try and, and decrease some of that loss, but then also just supporting through it-

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

... right? And it's important to focus, you know, there is a lot of value and perspective, um, but we wanna make sure that that perspective, well, you know, at least you survived, at least you didn't miss your senior prom, only your junior prom. You know, we have to be careful what that at least, because then it doesn't always leave room for the feelings that, that really are very appropriate in this situation.

Dr. Seth Rotz:

Yeah. It's, it's so tough, especially when we think about teenagers and we're thinking about wanting to get them through a cancer diagnosis and thinking about, you know, the many decades of their life afterwards. But, you know, if you think back to being a, a teenager yourself, how, how acute those concerns are in, in missing those events, it's really tough because on, at one point, you know, we're, we're professionals, and we're trying to think about the big picture, but also, you know, there's these things that really matter to people at that time period.

Dr. Kate Eshelman:

Absolutely. And we often kind of refer to ourselves as the quality of life doctors. You know-

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

... I can't prescribe medication, I'm not implementing, um, a medical treatment, but we really do wanna focus on these things. And sometimes that looks like a conversation with the families or the providers about, you know, why this is so important, you know, maybe why this child is reacting the way that they are, or, you know, did or didn't do something that, that they were quote-unquote "supposed" to do.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

And helping people understand these kind of developmental phases and the importance of those.

Dr. Seth Rotz:

So, Dr. Eshelman, another conversation that can be tricky, or another transition that can be tricky is when, when patients are finishing, um, treatment. You know, at that point, a lot of the difficulties behind, but it takes time to get back to some semblance of, of normalcy. What are those transitions like for patients and families, and how do you navigate those discussions?

Dr. Kate Eshelman:

Yeah, I think we often try and, um, really start preparing in advance as we, we begin considering end of treatment. You know, I think most people get excited very appropriately, um, and they just expect that treatment's gonna be over, and life is gonna go back to the way that it was, and it's all gonna be positive feelings. And I think what we've learned over time is, while some of that may be true, it's also a big adjustment.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

You know, families are used to coming to clinic every day. We have wonderful fun nurses, art therapists, music therapists that really become these patient social lives.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

And so when that part decreases, that can be difficult. Um, you know, I think for families, there's a level of comfort that is associated with seeing a, a medical provider twice a week-

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

... having regular labs. And so-

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

... kind of living with, um, that anticipatory anxiety about kind of what if? You know, "What if the labs are off? Um, how am I gonna know?"

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

So kind of preparing for that, and then also preparing for that things may not look like they did before. You know, at the very least, there's been a passage of time, you know, generally at least months-

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

... if not years. And so, developmentally, things likely would've been different anyway.

Dr. Seth Rotz:

Yeah, very true.

Dr. Kate Eshelman:

And so how do we start these conversations, um, with families, you know, that we're still hopeful and looking forward to this end of treatment and moving on.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

And these are the things that we might wanna think about or prepare for.

Dr. Seth Rotz:

Yeah. And then un- unfortunately for a, a segment of the patients that we treat, you know, life isn't ever gonna go back to normal, and some of these patients will, will relapse. Are those conversations fundamentally different for you?

Dr. Kate Eshelman:

They can be.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

Um, and I think that, you know, on the one hand, when we think about relapse, um, you know, it is a reality.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

So oftentimes when we think about anxiety, um, it's often kind of based on irrational or distorted fears.

Dr. Seth Rotz:

Okay.

Dr. Kate Eshelman:

And if we're worried about a massive hurricane in Cleveland, that is irrational 'cause it doesn't happen. But for these families, it's a hundred percent likely-

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

... because it's already happened. And so how do we manage that anxiety while still again, supporting, um, thriving, you know, going forward?

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

And so it's a lot of, you know, using some of those cognitive behavioral therapy techniques, um, as well as like acceptance commitment therapy techniques to acknowledge these possibilities and live with them.

Dr. Seth Rotz:

Yeah. One of the things that we'll see, um, in our survivorship clinic is, you know, symptoms of post-traumatic stress, and we'll see those in patients, but, um, frankly, we see them more, more frequently in our, our parents. I'm wondering, you know, have you had a lot of experience dealing with patients and families with post-traumatic stress from treatment? You know, oftentimes, a patient may not have been seen in 15 or 20 years, but they'll, they'll come back with their mom and, and for, for that family, it's like, it was, it was yesterday.

Dr. Kate Eshelman:

Yeah. I think, um, something to be grateful for is that there have been so many advances in treatment, you know, advances in supportive care, meaning, managing the side effects of treatment, but also, you know, really this development and implementation of the psychosocial care for families that go through treatment. And so, you know, hopefully, we're going to be seeing less of that-

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

... as we try and catch these things up front. But certainly, it does still exist, and our goal is, is to support, you know, and refer in the way that's necessary.

Dr. Seth Rotz:

You know, so far we've, we've talked about a lot of difficult conversations. Um, but for some of our patients, you know, ultimately, there'll be a point where we don't have any more medical therapy that's potentially curative for them. We're, we've reached a point where we know that they won't be curated their disease. Um, and these are really difficult conversations for us as physicians. They're difficult for everybody involved. How, how do you navigate those discussions?

Dr. Kate Eshelman:

And I think it is just so important to, to emphasize that they are very difficult. And I think oftentimes, parents and families, um, in the care of their children, wanna avoid these conversations-

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

... in a, in a way to protect them. But what we want parents to know is that oftentimes, regardless of their age, kids know what's going on with their body. Even young kids realize that something is different, something is changing. Um, and older kids, while they realize that, they also have access to technology-

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

... and are probably looking stuff up on their own. And if we don't create opportunities for these conversations, then the kids don't have the opportunity to express them.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

To express their concerns, to ask their questions. And that's really important. The other thing is that if we're talking about end of life, we want to give kids, again, of any age to make preparations for their death. You know, do they wanna draw pictures? Do they wanna send cards? Do they wanna make sure that they do something or talk to someone? And so we wanna make sure that we leave space for these opportunities, which we can't do if we don't talk about it.

Dr. Seth Rotz:

Mm-hmm.

Dr. Kate Eshelman:

So it can be very difficult, but it's important for families to know that there are a lot of supports in place to support the child through this and the parents through this as well.

Dr. Seth Rotz:

One of the things we haven't talked about yet, a medical team that we work closely with, with all families, not just patients who, who can't be cured, is our palliative care team. And palliative care is important in terms of helping us deal with all sorts of symptoms. And people, you know, frequently think about them in end of life situations, but they're absolutely integral to how we manage a lot of different issues with patients. Can you talk about your relationship with palliative care team? What you do, what they do, how it might be different?

Dr. Kate Eshelman:

And I think, um, just as you said, it's a team. So palliative care-

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

... is often made up of the physician, the nurse practitioner, they have a dedicated social worker, they have a nurse care coordinator, they're a team of teams, as Dr. Hannah likes to say. Um, but, you know, we collaborate very easily with them. Um, so, you know, just so families know, we have a standing meeting every Wednesday morning, um, where we really focus on the psychosocial aspects of, of patient's care. And so, you know, that translates to palliative medicine as well.

Um, they are medical providers, and so in addition to medication to support the physical symptoms, they are also knowledgeable about and comfortable in prescribing medications that can support the, the psychological symptoms as well. They are have a lot of resources that they can offer families that, again, are unique to, to the situations that the families that they serve are in.

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

Um, so there's a lot of collaboration. You know, with a lot of the psychosocial providers, there's overlap in what a lot of us can do-

Dr. Seth Rotz:

Mm-hmm.

Dr. Kate Eshelman:

... as well as unique aspects that we can bring to the patient's care.

Dr. Seth Rotz:

And sometimes patients and families make a connection to one member of the psychosocial team or another. And, you know, one person's role can become, you know, a little bit more primary and somebody else secondary depending on, on who clicks.

Dr. Kate Eshelman:

Absolutely. Then that provider then can also kinda serve as a liaison-

Dr. Seth Rotz:

Yeah.

Dr. Kate Eshelman:

... um, to, to help with that team communication.

Dr. Seth Rotz:

Yeah. Absolutely. Well, thank you so much for being here today, Dr. Eshleman. You know, as we talked about, there's no one easy way to have these conversations. You know, some of the pearls you mentioned is, is to make sure that you're meeting patients and families where they are, and giving age appropriate information to everybody. Not trying to mask things, but give, uh, concrete information that people can use in an age appropriate way.

Dr. Kate Eshelman:

Thank you for having me.

Dr. Seth Rotz:

Your child's cancer diagnosis starts a tough journey, and these conversations are a necessary step, uh, even though they're not easy. For anybody out there who'd like to schedule an appointment with Cleveland Clinic Children's Pediatric Hematology Oncology, you can give us a call at 216-444-5437. Thanks so much.

Speaker 1:

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