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Patient Handout

Talking With Your Children

Harpham, Wendy MD, FACP

doi: 10.1097/01.COT.0000489523.11131.ed
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Wendy S. Harpham, MD, FACP
Wendy S. Harpham, MD, FACP:
Wendy S. Harpham, MD, FACP, is an internist, cancer survivor, and author. Her books include Diagnosis Cancer, After Cancer, When a Parent has Cancer, and Only 10 Seconds to Care: Help and Hope for Busy Clinicians. She lectures on “Healthy Survivorship,” and as she notes on her website ( and her blog (, her mission is to help others through the synergy of science and caring.

After a cancer diagnosis, many patients face the challenge of what to tell their children. To make informed decisions, parents need to know the risks of lying and the benefits of telling the truth. As highlighted in The Problem of Parents' Lies (Oncology Times 6/25/16 issue), you may be the one person who can convince some patients of the value of telling their children the truth. Here's a patient handout that you may edit or use, as is.

The Best Way to Talk With Your Children

Dear Patient,

There is no absolute right way to raise children when a parent has cancer. The good news is that there is a best way for your family—something only you can know. Determining “best” depends on sound information about what helps children and what harms them. This handout reviews the risks of lying and the benefits of telling the truth. The answers reflect the advice of experts (child life specialists, pediatricians, social workers, doctors), based on research studies and decades of experience.

What if you want to keep your diagnosis a secret?

Naturally you want to protect your children. Maybe you feel a duty to shield them from stress and uncertainty. Maybe you want to preserve their innocence. Or maybe you assume your children are too young to handle the truth.

Keeping your diagnosis a secret may seem like a better path for you, too, while you're dealing with the stress of cancer. Besides avoiding the additional stress of breaking the news to your children, you can maintain your sense of being the same healthy parent—a good feeling while so much else about you is changing.

The problem is that you can't keep cancer a secret, no matter how hard you try. Studies have shown that secrecy can make life more difficult for your children now and can have long-term detrimental effects.

What are the risks of lying to your children?

Children notice everything. They constantly draw conclusions about what they are seeing, hearing and feeling. If you try to keep your diagnosis a secret, your children may...

  • Draw inaccurate conclusions that are worse than reality.
  • Not trust your answers; worry about what you might be hiding.
  • Not share their fears with you; suffer from anxieties.
  • Keep questions to themselves; suffer from confusion.
  • Find unhealthy ways of coping with the changes in their world.

In addition to those short-term problems, some children grow up with lifelong difficulties dealing with medical issues and/or trusting others.

Keeping secrets adds stress to your load, too. You need to invent and keep track of your lies. You're always on guard to prevent your children from finding out the truth. Sooner or later they will find out, and then you may have to deal with their anger and not believing you when you need them to.

Won't the truth overwhelm them?

No, not if you talk to them on their level using age-appropriate language. Not if you focus on hopeful truths. The key is to tell your children enough—and not everything. The core truths they need to know are: “I have an illness called cancer. I am getting great care. We will get through this together.”

Excellent resources offer practical advice for talking with your children. You'll find hopeful ways to deal with all the specific issues that arise in different medical situations at all phases of survivorship.

Why do experts recommend you tell your children the truth?

When you tell the truth, you create a bond of trust that...

  • Empowers you to provide healthy and hopeful interpretations of the changes at home.
  • Empowers you to respond optimally to their needs for comfort, information and support.
  • Empowers you to guide them to healthy, hopeful ways of coping.
  • Empowers you to continue being a good parent under trying circumstances.

Whatever their ages, you'll strengthen your children's self-esteem with the underlying message: I believe you can handle the truth. You'll fortify family bonds by dealing together with each big and little challenge.

Telling the truth is healing for you, too. You won't waste energy trying to act normal in an abnormal situation. In your search for ideas and words to help your children, you'll discover insights and mantras that help you.

What do children want parents to know?

When asked what helps them deal with their parent's cancer, children who are included in the family crisis say the same thing: “The one thing that helps most is that I am always told the truth.” Those children never like getting upsetting news, of course. But they want you to know that the truth is better than guessing what's going on or worrying that their parents are hiding a problem. They share a belief that nothing in the world is too scary or awful to talk about, no challenge too great to get through together.

What if you want to tell the truth but can't do it yourself?

You may not feel up to the task of telling your children about your cancer. Maybe you are shocked and distressed, and you need more time to adjust. Or you're too sick and need immediate treatment. That's okay. Ask a familiar and trusted adult in the children's life to break the news, such as a grandparent, aunt, uncle, close family friend, the children's pediatrician, or a member of clergy. Alternatively, a professional (such as a child life specialist or social worker) can lay the groundwork for open communication between you and your children. Delegating is not failing your responsibility; it's fulfilling it by doing what's best for the children.

What now?

Keep us informed of what you are telling your children. Tell us if parenting responsibilities are upsetting you. Ask for a list of local and national resources on helping your children. The truth will set you free, even if it hurts when you share it.

Wolters Kluwer Health, Inc. All rights reserved.
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