Abstract
In this issue, Weiss and Fiester’s (2018) “From ‘Longshot’ to ‘Fantasy’: Obligations to Patients and Families When Last-Ditch Medical Efforts Fail” calls attention to the weight of clinician word choice when discussing interventions in the pediatric population. Their work focuses on communication in a highly narrow slice of intervention options, from unlikely to work therapies to impossible ones. Regardless of a therapy’s low probability of success, physicians and parents suffer from forms of misconception: physicians tend to be overly optimistic in both their prognostic estimates and in their disclosure of illness severity, and parents tend to be highly likely to believe that their child is the one of many who will benefit from therapy. For Weiss and Fiester’s proposal to work, clinicians must realize and acknowledge early on that a “longshot” therapy is unlikely to work. This insight allows the team to share this understanding with the family and for the family to then, the authors assume, process the information. Adequate communication is a core clinical skill, yet not one innate to the best clinicians and few evidence based resources exist to support clinicians in achieving mastery in this arena. (One notable exception is Vital Talk [www.vitaltalk.org], however, the program is not specifically geared towards pediatric providers.)