The diagnosis of cancer creates enormous emotional turmoil, especially when the person receiving the diagnosis is your child. Such a diagnosis introduces significant emotional ‘noise’ into the dynamic between caregivers, patient and family, and increases the communication challenge.

It is at just this crucial, tumultuous time that the partnership between the medical team and the family is established. Both family and medical practitioner are thrust into this partnership and it is of the utmost importance that a relationship be established that is based not only on excellent medical care, but on open communication, trust and mutual caring.

In the paediatric oncology world there isn’t the advantage of a prior relationship. Soon after the diagnosis is made a very specific and special relationship needs to be fostered.  We embark on a journey together, a journey that, as a treating physician, I find is always unique and always a privilege to be part of.  It becomes an intimate relationship where you truly see families at their weakest and their strongest.

Family dynamics are challenged and the care experience of the family and patient is deeply impacted by the trust relationship that is established. The diagnosis of childhood cancer has enormous ramifications. One child’s illness can impact the nuclear family, the extended family, the child’s social network, soccer teams, school, scouts and religious communities. Up to as many as 600 people’s lives can be touched by the diagnosis of one child.

In the multidirectional caregiver partnership the ability of parties to listen to one another effectively and to truly hear one another is influenced by numerous factors and frequently undermined by divergent individual foci. The result is often miscommunication.

Our interactions are influenced by our personal and culturally different perspectives—the many basic differences that make us who we are. If we do not overcome these different perspectives, walls can be built up within this relationship and may become insurmountable.

We all come from different perspectives - with similar goals but different foci: the physician focusing on diagnosis, treatment, outcomes and medical delivery. The family, coloured by emotional turmoil, is focused on care, hope and cure. Initially the family may be numb and when one speaks they may not hear. Information needs to be repeated, reinforced. In this situation, how the news is delivered is much more important than what is said.

The fundamental building blocks are trust and the ability to listen to each other. During this journey we each listen to different things. It is important to remember this is about sharing information: not only are we giving information but we are receiving information in return.

We are all intellectually, emotionally and culturally influenced by that information and as we deliver the information, as care providers we need to truly know ourselves and acknowledge that we do not come to the relationship value-free. We need to understand our own biases and value systems, so that our own perspectives do not become a source of conflict in the relationship with families.

To enrich the care giving experience and empower the team, communication is vital; not only so that all parties can share their needs and hopes for the future, but also so that fears are explored too and not just swept under the carpet.

We are all human and being human means being real. Conflict is inevitable; but rather than finding fault, we need to take time to find the remedy, take time to step back and listen and try to understand our different perspectives. In this way hopefully we will be able to journey on, acknowledging that we will always have these different perspectives.

In summary, the relationship that the care provider has with the families is a journey that starts when we are forced together; this can be a very rich journey, unique in every way. As we experience personal growth, we recognise our own needs, not ignoring conflict but cultivating skills to empower us.

Relationship building is what makes being in paediatric oncology so special. It takes time and this is often a challenge in busy clinics when time is not always a privilege granted us. We need to listen to each other, not just to the words but to the feelings that they convey, and sometimes conceal. The foundation of these relationships is one of trust and being human. As Viktor Frankl so eloquently wrote, “being human means being conscious and being responsible.”