Be honest with children about cancer, experts advise after Princess of Wales diagnosis

Psychiatrists say parents underestimate children’s ability to understand something is wrong – and talking soon after diagnosis is best

Parents who have cancer must be “honest” with their children about the disease, Oxford University experts have said after the Princess of Wales revealed her diagnosis.
Leading psychiatrists said parents “often underestimate” their children’s ability to discern that something is wrong when approaching conversations about serious illness.
The Princess said in her video statement that finding out she had cancer was a “huge shock” and it had taken her and William “time to explain everything to George, Charlotte and Louis in a way that is appropriate for them, and to reassure them that I am going to be OK”.
The children, who are 10, eight, and five respectively, will each have a different level of understanding of cancer and what it means.
But experts say that “effective communication” is key to limiting the anxiety of uncertainty among children of all ages and advise having conversations “as soon as possible” after diagnosis.
Professor Louise Dalton, from the University of Oxford’s department of psychiatry, said it was understandable that parents “want to protect children from difficult or emotionally painful situations and often underestimate how much even very young children notice and understand about what is happening within the family”.
She said research has proven that children want to know when “an adult they love is ill” and talking about it “is associated with better psychological functioning” for the child and leads to “better family functioning and mental health outcomes for everyone”.
Professor Elizabeth Rapa, who with Prof Dalton is leading work into the importance of communicating serious illness to children, said it was also important to “share and explore some of the emotional impact of the news”.
“It’s important to include children in conversations about illness in the family as soon as possible so that they have time to understand and make sense of the situation and they are not left to worry alone,” she said.
Prof Rapa said adults needed to be “authentic about some of the uncertainty and psychological challenges” that being unwell poses and added that such honesty helps children to open up and share their own feelings.
“Normalising their emotional reactions and reassuring children about how the family will look after each other helps to contain anxiety and provides a shared focus,” Prof Rapa added.
Being transparent with a child about a cancer diagnosis is also advocated by leading cancer charities.
Advice from Cancer Research UK says that “being open and honest is almost always the best way with children. Remember that uncertainty or not knowing may be harder for them to cope with than the truth.”
It cautions parents to tailor the message to the child’s age, with younger children’s more basic grasp of illness potentially causing them to worry they have done something wrong or making them less able to articulate how they feel, which may then impact their behaviour.
Older children will have a “better understanding of how the body works” and may instinctively know if information is being withheld.
Macmillan Cancer Support says: “It is best to be honest with children. If they think you are being vague or hiding something, they may find it hard to believe they are being told the truth. Do not make things sound less serious than they are.
“It is fine to say you don’t know if you cannot answer all their questions. Tell them you will try to find out and will tell them when you know.”