Communicating cancer diagnoses with children in Japan: A qualitative study of healthcare professionals’ beliefs and approaches in pediatric oncology

Background Most children with cancer want clear and honest information about their illness, and effective communication can support coping and reduce distress for children and families. However, in Japan, healthcare professionals face numerous communication barriers when discussing cancer diagnoses with children, and the culturally grounded beliefs and approaches shaping these conversations remain poorly understood. Objectives This study was aimed at clarifying the beliefs and approaches of Japanese healthcare professionals in communicating cancer diagnoses to children and their families. Design An exploratory qualitative design was adopted, involving semi-structured individual interviews. Methods Participants included 18 healthcare professionals (9 physicians and 9 nurses) with over seven years of experience. Data were analyzed using thematic analysis. Results Five approaches were identified under an overarching commitment to the child’s best interests: 1) honesty balanced with emotional protection, 2) empathetic negotiation with families, 3) information sharing to ensure understanding and hope, 4) being present in suffering, and 5) professional self-reflection and mutual team support. While these themes resonate with international literature on honest and supportive communication, two culturally salient features emerged in Japan: a strong tendency to prioritize families’ wishes in decision making and a relational emphasis on “being present” rather than relying solely on structured, protocol-driven conversations. Communication was hampered by a lack of standardized training and a shortage of pediatric oncology nurses due to staff rotation. Conclusions Pediatric cancer diagnosis communication in Japan is shaped by five approaches that prioritize the child’s best interests. Locally grounded strategies highlight the importance of trust, relationship building, and being present, but may limit children’s voices when family preferences dominate. It is essential to employ nurses who specialize in pediatric cancer care. Future research should incorporate the children’s and families’ perspectives and evaluate culturally sensitive communication strategies.