Toward Better Conversations: Assessing Caregiver–Child Communication in Pediatric Oncology

Purpose Effective parent–child communication is central to coping with the psychosocial challenges of pediatric cancer, yet few studies have examined how caregivers and children perceive their communication. This study investigated congruence and discrepancies between caregiver and child reports of communication and associations with family relationship quality. Methods Seventy-six caregiver–child dyads (N=152) were recruited from two Midwestern pediatric hospitals. Children aged 8–17 with cancer and their caregivers independently completed measures of parent–child communication (PCCS) and family relationships (PROMIS). Descriptive statistics, correlations, and paired- and independent-samples t-tests were used to examine differences and associations across dyads, with attention to demographic and clinical factors. Results Both caregivers (M=3.95, SD=0.58) and children (M=4.15, SD=0.61) reported generally high-quality communication. However, significant discrepancies emerged: children rated caregivers as more attentive listeners (t(74)=2.53, p=.01), emotionally open (t(74)=2.30, p=.02), and willing to discuss problems (t(74)=2.86, p=.005) than caregivers reported their children. Child-reported communication correlated strongly with child-reported family relationships (r(75)=.75, p<.001), while caregiver reports were moderately associated with both their own and children’s assessments of family relationships. Age effects were observed, with older parent and child age linked to lower communication scores, and non-Hispanic caregivers reporting higher-quality communication than Hispanic. Conclusions Systematic discrepancies in caregiver and child perceptions of communication represent an underrecognized factor influencing family functioning in pediatric cancer. Findings underscore the importance of routine communication assessment and highlight the need for developmentally and culturally tailored interventions. Supporting families in bridging perception gaps may enhance psychosocial adjustment, strengthen family resilience, and improve treatment adherence.