Involvement of pediatric patients in decision making about their cancer care should be standard according to national and international guidelines. However, incorporating children into discussions about their cancer care is difficult due to a complex interplay of varying factors: developmental and cognitive ages of patients, parents’ emotions and background, and limitations in clinician’s resources. Interventions such as multiple disciplinary working, reducing emotional burden, and educational resources may help. However, shared decision making may not always be appropriate given standardized treatment protocols, as most pediatric cancers are treated with curative intent. A proposed model of decision making is based on the clinical scenario. Pediatric cancer patients with poor prognosis have a better quality of life when early preparations are made. This means that clinicians need to have good discussions with the patient and family early about likely poor prognoses. Unfortunately, there is a discordance between clinician and parents’ perceptions of prognosis, suggesting inadequate communication regarding prognosis. This chapter also discusses the difficulties of poor prognoses discussions from a patient, family, and healthcare professional perspective and how to tackle these in a healthcare setting.