Clinical and Electromyographic Effect of Tui-Na Massage Versus Positional Release on Postpartum Neck Dysfunction: A Randomized Clinical Trial.

Effective and timely referral to specialist pediatric palliative care (SPPC) is widely recognized as a critical component of high‐quality care for children with serious illness and their families. SPPC is a multidisciplinary approach that addresses the physical, emotional, psychosocial, and spiritual needs of children with serious illnesses and their families. SPPC aims to improve quality of life throughout the illness trajectory, regardless of disease stage or prognosis [, , ]. SPPC has been shown to improve symptom management, enhance quality of life, and support decision‐making [, , , ], however, referrals often occur late in the disease trajectory, or not at all [, ]. While structural and systemic barriers to SPPC integration have been well documented [, , , , ], relatively little attention has focused on the role of communication in shaping referral initiation and acceptance and family engagement with SPPC [, , ]. In particular, how and when SPPC is introduced, described, and discussed with patients and families likely influences perceptions of its purpose and, ultimately, the willingness of patients and their families to accept SPPC involvement. Communication challenges in this context are multifaceted and likely occur throughout the patients' cancer trajectory, though what precisely these communication challenges are, remains largely unexplored. In a recent review of nearly 200 papers on barriers and facilitators to SPPC referral the authors note that ‘staff communication skills and information provision’ were named as a barrier in 28% of the studies and a facilitator in 17% of the articles they reviewed []. ‘Staff communication and information provision’ are broad terms that provide little insight into what aspects of communication or the provision of information are effective, or counterproductive, in a resulting SPPC referral. While some studies have been more concrete in naming factors such as anxiety and discomfort around discussing palliative care [, , , , ], and the withholding of prognostic information from patients and families as barriers to SPPC integration and referral [, ], most of the literature notes that communication is important, but does not specify about this communication works when discussing SPPC with families and patients. To address this gap, the present study explored healthcare providers' perspectives on the role of communication in SPPC referral, SPPC acceptance on the part of the family and ongoing SPPC integration within pediatric oncology settings in Canada. Using qualitative methods, we examined how communication with patients and families, as well as interprofessional communication between teams, shaped the acceptance and integration of SPPC services.