Standard of Care (SOC) control will be provided with written information that encourages conversation the treatment team. At Children's National the following represent hospital policy: " … regarding advance directives … to honor each non-minor patient's wishes … to encourage and assist patients in determining and expressing their preferences regarding treatment decisions for use in the event they subsequently become unable to make such decisions." Upon admission if they do not have an advance directive, they should be given the "Advance Directive Information Booklet" and the Advance Directive Checklist. If they already have one, the patient is asked to provide a current copy, and it is placed in the medical record.

Decisional Conflict Scale is used to measure the degree of uncertainty about the course of action to take. The DSC consists of three subscales on a five-point Likert scale from 1 (strongly disagree) to 5 (strongly agree), e.g., "This decision was hard for me to make." The DSC demonstrated good test-retest item reliabilities (r≥.80).

Beck Anxiety Index (BAI). This is a 21-item measure assessing severity of subjective, somatic, and panic-related symptoms of anxiety. Participants rate the degree of discomfort experienced as a result of each symptom over the past week on a 4-point Likert scale (range 0-3). Items are summed with a maximum possible score of 63. Scores of 0 to 7 indicate minimal anxiety, 8-15 indicate mild anxiety, 16-25 indicated moderate anxiety, and >26 indicate severe anxiety. Test-retest reliability for this measure is acceptable (r = .75) as is internal consistency reliability (α = .92). The BAI has also demonstrated adequate content, concurrent, construct, discriminant, and factorial validity. This measure was validated to clinically assess severity of anxiety in individuals aged 17 to 80, however will be extended to the younger age range of this study to allow for consistency of data collected by a single measure of anxiety.

Five Wishes© (Towey, Aging with Dignity Component developed with support from The Robert Wood Johnson Foundation) is a legal document that facilitates having people express their treatment preferences if they were seriously ill or unable to communicate their wishes. The adolescent completed this along with their parent/proxy during the third experimental session. For adolescents under age 18, the Five Wishes© must be signed by their parent or legal guardian to be legally sufficient.

Threat Appraisal Scale (TAS)is a questionnaire administered to the adolescent during baseline assessment only. This measure will retrospectively estimate the adolescent's threat appraisal of cancer when adolescent learned of cancer diagnosis. Test-retest reliability for this measure ranges from .68 in younger children to .93 in older children. TAS scores are found to demonstrate a high degree of agreement with children's open-ended descriptions of negative life events, indicating adequate convergent validity of this measure. Theoretically, threat appraisal is related to Lazarus' concept of primary appraisal, particularly to the way in which the event threatens the child's commitments, goals, or values. Higher threat appraisals should lead to negative arousal and coping and to increased psychological symptoms.

Spiritual Well Being Scale of the Functional Assessment of Chronic Illness Therapy - Version 4 (FACIT-Sp)is a questionnaire administered individually to both adolescent and guardian/surrogate. This measure will investigate spirituality as a protective process. This 23 item scale focuses primarily on the existential aspects of spirituality and faith. There are two subscales: meaning/peace and faith. The FACIT-SP has been used to study spirituality in teens with chronic illnesses.

The Pediatric Quality of Life Inventory™ 4.0 (PedQL™ 4.0). Adolescent and parent/surrogate will complete independently the age-appropriate self-report version and the parent proxy report version. This is a 23-item modular instrument designed to measure health-related quality of life (HRQOL) in children and adolescents. It measures four dimensions of functional quality of life (Core Scales: Physical, Emotional, Social, School) applicable to pediatric populations with acute and chronic health conditions. This measure was selected, because it has the strongest norms, validity, and reliability of the measures available.

The Satisfaction Questionnaire assesses negative and postive emotional reactions to participating in the study on the part of the adolescent and the surrogate decision-maker/family member. It was designed specifcally for this study based on community based participatory research.