Should I tell my children the truth about advanced cancer?

Yes. The National Cancer Institute says children deserve to be told the truth about a poor outlook, and that hiding it leaves them unprepared and can make their grief last longer.

Children of all ages sense when something is wrong. You are not choosing between telling them and protecting them. You are choosing between telling them and letting them guess.

What children do when they are not told

They fill the gap with imagination, and what they invent is usually worse than the truth.

NCI is specific about the fears that surface. A child may believe they did something that caused you to get sick. A child may fear that no one will take care of them. A child may notice you are not spending as much time with them and draw a conclusion about why.

There is a second cost. If you do not talk about your condition, or do not tell the truth about it, your children may have a hard time trusting other people later on. Their trust in you is what keeps them steady now, and it is worth guarding.

Watch for how the strain comes out. Some children become very clingy. Others get in trouble at school or at home. Tell the teacher or school counselor what is happening at home so the adults around your child are not guessing either.

What to actually say

Six things do most of the work.

• Be honest. Tell them you are sick and that the doctors are working to keep you comfortable.
• Tell them nothing they did or said caused the cancer, and that they cannot catch it from you or anyone else.
• Tell them you love them. Tell them it is okay to feel upset, angry, or scared.
• Be clear and simple. Children do not hold attention the way adults do. Use words they already know.
• Tell them they will always be taken care of and loved.
• Tell them questions are welcome, and that you will answer as honestly as you can.

If a child asks whether you are going to die, you can tell them the truth with comfort. What you say, and how they take it, depends on their age and on what they have already lived through.

Teenagers and adult children are different jobs

Teenagers need the truth too, and hearing it can spare them guilt and stress. But expect avoidance. Some get angry or act out. Some withdraw. Give them room, especially if you now rely on them more at home. Tell them plainly to keep going to school, keep playing sports, and keep doing the things they enjoy. Many teens would rather talk to a friend, coach, teacher, or youth minister than to you, and that is fine.

Adult children carry their own load. They may become frightened of their own mortality. They may feel guilty for being pulled between their jobs, their kids, and you. What helps is sharing decisions with them and involving them in the things that matter to you, such as treatment choices and plans for the future. Doing that early can also head off arguments between siblings when hard decisions arrive.

Talking about death itself

Children of any age wonder about dying, about what happens to the body, and about what comes after. Answer the questions they ask. Unanswered ones get replaced by invented ones.

Know your own views before you start, including what you are hoping for and what you think may happen. You can show a child how to hope for the best while accepting that death may be the outcome. Being honest teaches them that death is part of life and that it is allowed to be discussed.

You do not have to run this alone. A counselor or oncology social worker can suggest words that fit your child's age, and can point you to local or national programs, books, and videos made for exactly this. NCI's booklet "When Someone You Love Is Being Treated for Cancer" goes into more detail.

Sources

https://www.cancer.gov/about-cancer/advanced-cancer/talking