Background: Spiritual care is recognized as an essential component of standard care for children with cancer and their families. Oncologists lack training in navigating spirituality discussions in primary cancer care. The current landscape of spiritual dialogue during clinical oncology encounters remains understudied. Procedures: This qualitative study aimed to describe the frequency, context, and content of religious and spiritual communication between pediatric neuro-oncologists, caregivers, and patients with brain tumors during disease reevaluation encounters. This study is part of the U-CHAT trial (NCT02846038), a prospective longitudinal investigation of realtime clinical communication across the trajectory of poor prognosis cancer. Patients with brain tumors and their caregivers were eligible if their primary oncologist estimated survival ≤ 50%. All disease reevaluation encounters for enrolled patients were audiorecorded and underwent rapid qualitative analysis to identify, summarize, and synthesize religious and spiritual communication. Results: Religious or spiritual references were identified in 23 (18%) of 129 total encounters. References usually comprised a single religious or spiritual term, with “prayer”-related language representing the majority of references. Caregivers introduced spirituality dialogue more often than oncologists (65% vs 35%). References were most often identified in the context of discussion about an uncertain or uncontrollable future. Conclusions: Results suggest oncologists rarely integrate spiritual care into disease reevaluation discussions. In light of recommendations from multiple consensus groups to integrate spiritual care into cancer care, future work should explore how generalist spiritual care training could better equip oncologists to attend to spiritual needs that arise along the cancer trajectory.

Background: The provision of Section 2302 of the 2010 Patient Protection and Affordable Care Act (ACA) allowed pediatric patients who are enrolled in Medicaid to receive hospice care concurrently with curative treatment (i.e., concurrent hospice care). Because it is a relatively new model of care and very little is known about the characteristics of children with cancer who receive it, the purpose of the current study was to compare demographic, health, and community characteristics of children who received standard hospice care versus concurrent hospice care. Procedure: This study was a retrospective, comparison study with national Medicaid files provided by the Center for Medicare and Medicaid Services (CMS). The sample included 1,685 pediatric patients under the age of 20 who were diagnosed with cancer, were enrolled in hospice between 2011 and 2013, and received standard hospice care (n= 1,008) or concurrent hospice care (n = 655). Results: Children of non-Caucasian race with multiple complex chronic conditions, mental/behavioral health problems technology dependence, and brain and orbital tumors, were more likely to be enrolled in concurrent care than in standard hospice care. The proportion of children enrolled in concurrent care versus standard hospice care was larger in rural areas, low-income communities, and in the Southern states. Conclusions: The enhanced uptake of concurrent care by traditionally underserved populations is promising. Concurrent hospice care, which allows for continued medical treatment and hospice care, could enhance access to hospice within these populations by offering a more blended model of care.