Abstract
Purpose
We explored pediatricians’ practices and attitudes concerning end-of-life discussions (EOLds) with pediatric patients with cancer, and identified the determinants of pediatricians’ positive attitude toward having EOLds with pediatric patients.
Methods
A multicenter questionnaire survey was conducted with 127 pediatricians specializing in the treatment of pediatric cancer.
Results
Forty-two percent of participants reported that EOLds should be held with the young group of children (6–9 years old), 68% with the middle group (10–15 years old), and 93% with the old group (16–18 years old). Meanwhile, 6, 20, and 35% of participants answered that they “always” or “usually” discussed the incurability of the disease with the young, middle, and old groups, respectively; for the patient’s imminent death, the rates were 2, 11, and 24%. Pediatricians’ attitude that they “should have” EOLds with the young group was predicted by more clinical experience (odds ratio [OR] 1.077; p = 0.007), more confidence in addressing children’s anxiety after EOLd (OR 1.756; p = 0.050), weaker belief in the demand for EOLd (OR 0.456; p = 0.015), weaker belief in the necessity of the EOLd for children to enjoy their time until death (OR, 0.506; p = 0.021), and weaker belief in the importance of maintaining a good relationship with the parents (OR 0.381; p = 0.025).
Conclusions
While pediatricians nearly reached consensus on EOLds for the old group, EOLds with the young group remain a controversial subject. While pediatricians who supported EOLds believed in their effectiveness or necessity, those who were against EOLds tended to consider the benefits of not engaging in them.
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References
U.S (2004) Cancer statistics working group. United States Cancer statistics: 2004 incidence and mortality. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention and National Cancer Institute, Atlanta
Ministry of Health, Labor and Welfare. Statistics and Information Department. Vital Statistics. Tokyo; 2013: http://www.mhlw.go.jp/toukei/saikin/hw/jinkou/geppo/nengai12/dl/h7.pdf (2013). (In Japanese)
Baile WF, Lenzi R, Parker PA, Buckman R, Cohen L (2002) Oncologists’ attitudes toward and practices in giving bad news: an exploratory study. J Clin Oncol 20:2189–2196
Otani H, Morita T, Esaki T, Ariyama H, Tsukasa K, Oshima A, Shiraisi K (2011) Burden on oncologists when communicating the discontinuation of anticancer treatment. Jpn J Clin Oncol 41:999–1006
Beale EA, Baile WF, Aaron J (2005) Silence is not golden: communicating with children dying from cancer. J Clin Oncol 23:3629–3631
Parsons SK, Saiki-Craighill S, Mayer DK, Sullivan AM, Jeruss S, Terrin N, Tighiouart H, Nakagawa K, Iwata Y, Hara J, Grier HE, Block S (2007) Telling children and adolescents about their cancer diagnosis: cross-cultural comparisons between pediatric oncologists in the US and Japan. Psychooncology 16:60–68
Bell CJ, Skiles J, Pradhan K, Champion VL (2010) End-of-life experiences in adolescents dying with cancer. Support Care Cancer 18:827–835
Young B, Dixon-Woods M, Windridge KC, Heney D (2003) Managing communication with young people who have a potentially life threatening chronic illness: qualitative study of patients and parents. BMJ 326:305
Scott JT, Harmsen M, Prictor MJ, Sowden AJ and Watt I (2003) Interventions for improving communication with children and adolescents about their cancer. Cochrane Database Syst Rev:CD002969
Kreicbergs U, Valdimarsdóttir U, Onelöv E, Henter JI, Steineck G (2004) Talking about death with children who have severe malignant disease. N Engl J 351:1175–1186
British Medical Association. (2001) Consent, rights, and choices in health care for children and young people. London: BMJ Books
DoH (2002) Core principles for the involvement of children and young people. Listening, Hearing, and Responding. London
Clarke SA, Davies H, Jenney M, Glaser A, Eiser C (2005) Parental communication and children’s behaviour following diagnosis of childhood leukaemia. Psychooncology 14:274–281
Durall A, Zurakowski D, Wolfe J (2012) Barriers to conducting advance care discussions for children with life-threatening conditions. Pediatrics 129:e975–e982
Kassam A, Skiadaresis J, Habib S, Alexander S, Wolfe J (2013) Moving toward quality palliative cancer care: parent and clinician perspectives on gaps between what matters and what is accessible. J Clin Oncol 31:910–915
Yotani N, Kizawa Y, Shintaku H (2017) Differences between pediatricians and internists in advance care planning for adolescents with cancer. J Pediatr 182:356–362
Sahler OJ, Frager G, Levetown M, Cohn FG, Lipson MA (2000) Medical education about end-of-life care in the pediatric setting: principles, challenges, and opportunities. Pediatrics 105:575–584
Kenyon B (2001) Current research in children’s conceptions of death: a critical review. Omega J Death Dying 43:63–91
Yoshida S, Shimizu K, Kobayashi M, Inoguchi H, Oshima Y, Dotani C, Nakahara R, Takahashi T, Kato M (2014) Barriers of healthcare providers against end-of-life discussions with pediatric cancer patients. Jpn J Clin Oncol 44:729–735
Mori M, Shimizu C, Ogawa A, Okusaka T, Yoshida S, Morita T (2015) A national survey to systematically identify factors associated with oncologists’ attitudes toward end-of-life discussions: what determines timing of end-of-life discussions? Oncologist 20:1304–1311
Granek L, Krzyzanowska MK, Tozer R, Mazzotta P (2013) Oncologists’ strategies and barriers to effective communication about the end of life. J Oncol Pract 9:e129–e135
Davies B, Sehring SA, Partridge JC, Cooper BA, Hughes A, Philp JC, Amidi-Nouri A, Kramer RF (2008) Barriers to palliative care for children: perceptions of pediatric health care providers. Pediatrics 121:282–288
Yoshida S, Hirai K, Morita T, Shiozaki M, Miyashita M, Sato K, Tsuneto S, Shima Y (2011) Experience with prognostic disclosure of families of Japanese patients with cancer. J Pain Symptom Manag 41:594–603
Peppercorn JM, Smith TJ, Helft PR, Debono DJ, Berry SR, Wollins DS, Hayes DM, Von Roenn JH, Schnipper LE (2011) American society of clinical oncology statement: toward individualized care for patients with advanced cancer. J Clin Oncol 29:755–760
Lotz JD, Jox RJ, Borasio GD, Fuhrer M (2013) Pediatric advance care planning: a systematic review. Pediatrics 131:e873–e880
Mack JW, Joffe S (2014) Communicating about prognosis: ethical responsibilities of pediatricians and parents. Pediatrics 133(Suppl 1):S24–S30
Balaban RB (2000) A physician’s guide to talking about end-of-life care. J Gen Intern Med 15:195–200
Funding
This study was supported by JSPS KAKENHI Grant Number 26780408.
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Yoshida, S., Ogawa, C., Shimizu, K. et al. Japanese physicians’ attitudes toward end-of-life discussion with pediatric patients with cancer. Support Care Cancer 26, 3861–3871 (2018). https://doi.org/10.1007/s00520-018-4254-6
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DOI: https://doi.org/10.1007/s00520-018-4254-6