Decision-Making at End-of-Life for Children With Cancer: A Systematic Review and Meta-Bioethical Analysis

Abstract

BackgroundEvidence shows that medical education includes a variety of basic and clinical skills. Ethical and human values are not typically considered in medical school curricula, and this is evident in medical practice in certain scenarios such as decision-making at pediatric cancer patients' end of life.MethodsThis study explores a bioethical approach to address complex decision-making at the end of life in children and adolescents with cancer. We are a cross-functional group of scientists from several academic disciplines who conducted a systematic review of the literature using our newly developed meta-bioethical analysis and synthesis of findings. The search was carried out in five databases, resulting in 10 research papers. Following quality screening, seven articles were ultimately selected for further analysis.ResultsOur focus is on the state of the art to better understand the bioethical deliberation at the end of life in pediatric oncology. Here, we report a systematic review that includes (i) classification of the screened articles by the type of decision-making they use, ii) the system values that are at the core of the decision-making at the end of life, and iii) bioethical and ethical discernment queries. We conclude with a discussion regarding the best practices of ethical discernment and decision-making at the end of life.This study highlights the need to develop more research to better understand the influence and origin of these multidimensional factors determining critical decisions that define the quality of life of patients in a highly sensitive moment.ConclusionWe conclude that personal aspects of the physician define their actions more than knowledge or organized structure. It is thus necessary that pediatric oncologists receive ethics and humanistic education.

Virtual reality for pain and anxiety of pediatric oncology patients: A systematic review and meta-analysis

“…One possible reason of significant reduction in the symptoms of anxiety is that coupled with weak physical resistance and susceptibility to infection, most children with cancer have relatively few opportunities to participate in leisure activities. 41 Restricted in hospital, children were lack of opportunities for children to play and their anxiety of hospitalization increased. 42 It is worthwhile to note that the studies used different modalities of VR to relieve anxiety.…”

Diffuse intrinsic pontine gliomas: First registry effort in Mexico

“…10 Palliative end-of-life care treatment is not a routine procedure, and as many as 60% of patients undergo invasive procedures or chemotherapy treatment due to a lack of ethical education regarding terminally ill patients, and decisions to initiate palliative care become a personal decision. 11 Routine tumor biopsy is still under debate, considering that diagnosis can be made with radiological studies 12 ; however, it is recommended before treatment if molecular targeted therapies are planned in a clinical trial. 13 The collection of postmortem tumor tissue can be an alternative to understanding biology; however, autopsies cannot always be performed.…”

“…Understanding that palliative care is part of the initial approach requires unified collaboration between pediatric oncologists and palliative end‐of‐life care subspecialists 10 . Palliative end‐of‐life care treatment is not a routine procedure, and as many as 60% of patients undergo invasive procedures or chemotherapy treatment due to a lack of ethical education regarding terminally ill patients, and decisions to initiate palliative care become a personal decision 11 …”

Ethical challenges as perceived by nurses in pediatric oncology units

“…7,8 Among the healthcare professions, providing care in oncology units is especially filled with ethical challenges in the domains of giving care, making end-of-life decisions, discontinuing or continuing treatment, determining the extent of treatment efforts, giving palliative care, and considering patients' preferences regarding discontinuing or continuing their treatment. 9 Occasionally, in the face of ethical issues, care providers make medical decisions based on their personal experiences, rather than an accurate knowledge of ethics. 8 Care providers' experiences depend on their age, years of work experience, number of patients they have made ethical decisions for, beliefs, religion, ethical training, local regulations, cultural factors, and personal values.…”

“…8 Care providers' experiences depend on their age, years of work experience, number of patients they have made ethical decisions for, beliefs, religion, ethical training, local regulations, cultural factors, and personal values. [8][9][10] Wrong ethical decisions result in failure to meet patients' physical and mental needs, their suffering, and, in turn, deterioration in their quality of life. Thus, it is essential that the ethical challenges in oncology departments, especially from the care providers' perspective, should be studied.…”