I agree with every point made in you discussion especially that it is essential to have a clear plan/goal when addressing this topic with the patient and family.  It would be essential to gain the parents perception and also do an independent assessment as the pre-pubertal patient may not share prior knowledge with the parent and allow the parent to think they are not ready mentally or emotionally.  I have personally found patients who pretend to not have prior knowledge or understanding when a parent is present but can educate me when alone and comfortable to share.

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