Communication in AYA survivorship clinical settings: Best practices and challenges.

Abstract

e22020 Background: Pediatric and adolescent/young adult (AYA) cancer survivors face long-term physical and psychosocial effects of their cancer treatment and are recommended to receive lifelong specialized survivorship care. While much research has focused on what information survivors need to know about their past cancer and future health, very little is known about how clinicians communicate with AYAs and their families about these topics. This study aimed to evaluate best practices and challenges with survivorship-related communication from the perspective of experienced clinicians. Methods: We conducted semi-structured individual interviews with 12 survivorship clinicians from diverse practice settings across the United States between 11/2024-1/2025. Interviews queried communication best practices, perceived barriers, and recommendations for improving communication in AYA survivorship settings. All interviews were recorded, transcribed verbatim, and qualitatively analyzed using Dedoose software to identify key themes and patterns. Results: Clinicians (9 female, 3 male) had been in practice for median 16.5 years (4-37 years) and were physicians specializing in pediatric oncology (N = 7, including 2 also with med-peds training) or primary care with a focus on survivorship (N = 3), or were nurse practitioners (N = 2). Clinicians cared for pediatric (N = 3), adult (N = 3), or all (N = 6) ages. Common barriers to effective communication included the complexity and volume of information (especially when feeling pressured to fit it all into one visit due to worry that survivors would not return to care), lack of time (exacerbated by extra time needed for language interpretation), and anxiety among AYA survivors and caregivers that affected communication dynamics among the triad (survivor, caregiver, clinician). Best practices for communication included building rapport (active listening, connecting on an individual level), a mindset to “meet the patient where they’re at” (prioritization of topics to discuss, not trying to address everything in one visit), use of clear, accessible language with visual aids, and contextualizing information such as health risks and associated uncertainty (adapting for past medical experiences that affect risk perception). Conclusions: Effective communication between clinicians and AYA cancer survivors has the potential to improve health outcomes by promoting AYA engagement with care. Clinician communication strategies may help survivors understand health risks and manage associated uncertainty and anxiety. Addressing barriers to communication will be a focus of future interventions.