# Mapping review on breaking bad news and design of SAFE & CARING protocol for pediatric hematology-oncology

## TL;DR

This paper maps existing protocols for delivering bad news and creates a new communication tool for pediatric hematology-oncology in Germany.

## Contribution

The novel contribution is the collaborative design of the SAFE & CARING protocol for triadic communication in pediatric hematology-oncology.

## Key findings

- Twenty out of 28 reviewed protocols contained content relevant to pediatric hematology-oncology.
- The SAFE & CARING protocol integrates practical and theoretical evidence for triadic communication.
- The protocol is designed as a first-aid tool for interdisciplinary teams lacking formal training in this area.

## Abstract

(1) to map existing Breaking Bad News (BBN) protocols and (2) to develop a context-specific, practical “first aid” triadic communication protocol, for the German pediatric hematology-oncology (PHO) setting where no such tool currently exists.

A mapping review was conducted to systematically identify existing BBN protocols. Building on this, theoretical and practical evidence was integrated in a collaborative concept mapping exercise with German PHO experts, resulting in the extraction of PHO-specific components, develop BBN categories, refine key concepts, and the design of a new context-specific protocol.”

Of the 28 reviewed protocols, 20 contained potential PHO-relevant content and were analyzed by time, origin, and target population. Seventeen protocols included components suitable for PHO. Integrating these components with practical evidence led to the creation of the acronym-based ‘SAFE & CARING' BBN protocol. It covers all three BBN phases: ‘SAFE’ supports preparation, while ‘CARING' guides delivery and follow-up. It conceptualizes BBN as interdisciplinary task and explicitly addresses the requirements of triadic communication.

The ‘SAFE & CARING' protocol is a structured, hands-on first-aid tool for interdisciplinary PHO teams, particularly in settings with limited formal training in triadic communication. Its key innovation includes the collaborative development process and the integration of triadic communication as an overarching principle.