Background To tell children that they are diagnosed with cancer is challenging for any healthcare professional and family. Pictures books are one of the communication tools for talking with children about severe diseases. However, little research is available about the contents and appropriateness of picture books about cancer for children. Methods This study aimed to examine the contents of children's picture books about cancer and explore the advantages and disadvantages of using picture

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... to communicate with children about cancer. We searched the picture books about cancer written for children aged under ten years old on the Amazon.com Web site on 5 July 2019 and hand-searched on the cancer-related institutes' Web site. We extracted the texts of relevant picture books and conducted a contents analysis of them. Two researchers independently coded the patterns and contents and calculated the agreement between the codings of two researchers using Cohen's kappa coefficient. Results We identified 2,555 picture books and included 30 of them. We identified three main contents, (a) cancer-related knowledge, (b) impacts of cancer, and (c) dealing with cancer. Cancer-related knowledge refers to the information about what is going on and what children have to do. Impacts of cancer refer to the impact of having a child with cancer. Dealing with cancer relates to the actions to reduce or minimize stressful events that had been described. These contents were written with simple words and illustrations. Some of them included the essential contents, which might be misunderstood by children. Conclusions Picture books use plain language with illustrations and might be helpful for children to understand about cancer. However, as these books do not include all contents, it is necessary to select and use multiple books depending on the content which is wanted to tell the child. Moreover, there was no picture book which was developed based on children's information needs and validated. Further research should evaluate the impacts of these books as a communication tool when talking with children diagnosed with cancer.