Ethical Decision Making About End-of-life Care Issues by Pediatric Oncologists in Economically Diverse Settings

Varela, Ana Milena Sanchez; Johnson, Liza‐Marie; Kane, Javier R.; Kasow, Kimberly A.; Quintana, Yuri; Coan, April; Yuan, Yading; Barfield, Raymond; Church, Christopher; Hester, Micah; Baker, Justin N.

doi:10.1097/mph.0000000000000271

Cited by 8 publications

(27 citation statements)

References 11 publications

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“…This study population was chosen because physicians are typically those making decisions around palliative care consultation and integration in this region. Initial survey items were developed on the basis of WHO guidelines and a review of the published literature on provider perspectives on palliative care, physician responsibility, and other ethical considerations 1,22‐25 . The study received a priori approval from the Instititual Review Board.…”

Section: Methodsmentioning

confidence: 99%

A multicountry assessment in Eurasia: Alignment of physician perspectives on palliative care integration in pediatric oncology with World Health Organization guidelines

Ehrlich

Movsisyan

Batmunkh³

et al. 2020

Cancer

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BACKGROUND: The World Health Organization (WHO) advocates for early integration of palliative care for all children with life-threatening illness. Provider awareness and misperceptions, however, can impede this imperative. In the Eurasian region, little is known about physician knowledge and perspectives on palliative care. METHODS: The Assessing Doctors' Attitudes on Palliative Treatment survey was developed as an evidence-based and culturally relevant assessment of physician perceptions on palliative care integration into childhood cancer care in Eurasia. Iteratively tested by American and Eurasian palliative care experts, the survey was culturally adapted, translated, and piloted in English, Russian, and Mongolian. The survey was distributed to physicians caring for children with cancer. Fifteen statements were scored in accordance with WHO guidelines to evaluate provider knowledge. The statistical analysis was complemented by a qualitative analysis of open-ended responses. RESULTS: This study received 424 responses from 11 countries in Eurasia. The mean alignment between provider perspectives and WHO recommendations was 70% (range, 7%-100%). Significant independent predictors of higher alignment included country, prior palliative care education, and greater experience with patient death. Respondents primarily described palliative care as end-of-life care and symptom management. Two-thirds of respondents (67%) reported not feeling confident about delivering at least 1 component of palliative care. CONCLUSIONS: This is the first study assessing physician perspectives and knowledge of palliative care in Eurasia and reveals wide variability in alignment with WHO guidelines and limited confidence in providing palliative care. Study findings will inform targeted educational interventions, which must be tailored to the local political, economic, and cultural context.

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Section: Methodsmentioning

confidence: 99%

A multicountry assessment in Eurasia: Alignment of physician perspectives on palliative care integration in pediatric oncology with World Health Organization guidelines

Ehrlich

Movsisyan

Batmunkh³

et al. 2020

Cancer

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“… 18 , 19 The survey items were developed based on WHO guidance and a review of published literature on physician perceptions of palliative care. 7 , 15 , 24 , 25 , 26 …”

Section: Methodsmentioning

confidence: 99%

“…The ADAPT survey was initially developed to evaluate perspectives of physicians of all specialties who care for pediatric oncology patients in the Eurasian region . The survey items were developed based on WHO guidance and a review of published literature on physician perceptions of palliative care …”

Section: Methodsmentioning

confidence: 99%

Physician Perceptions of Palliative Care for Children With Cancer in Latin America

et al. 2022

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“…The ADAPT survey was originally developed to better understand the perceptions of physicians who care for children with cancer on early integration of PCC . The methods for the adaptation of the ADAPT survey for Latin America has been previously described .…”

Section: Methodsmentioning

confidence: 99%

“…The ADAPT survey was originally developed to better understand the perceptions of physicians who care for children with cancer on early integration of PCC. 1,19,[28][29][30][31][32] The methods for the adaptation of the ADAPT survey for Latin America has been previously described. 25 In brief, the survey was translated into Spanish and evaluated by an expert panel to ensure items were consistent with the cultural context.…”

Section: Instrument Development or Who Alignmentmentioning

confidence: 99%

Ideal vs Actual Timing of Palliative Care Integration for Children With Cancer in Latin America

et al. 2023

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ImportanceEarly integration of pediatric palliative care (PPC) for children with cancer is critical for the quality of life of both patient and family. To improve access to PPC in resource-limited settings, barriers to early integration must be understood.ObjectivesTo evaluate the ideal vs actual timing of PPC integration for children with cancer and to uncover barriers to early integration identified by physicians in Latin America.Design, Setting, and ParticipantsThe Assessing Doctors’ Attitudes on Palliative Treatment (ADAPT) survey was distributed electronically from August 1, 2020, to January 31, 2021, to physicians who treat children with cancer in 17 countries in Latin America.Main Outcomes and MeasuresThe ADAPT survey queried for understanding of ideal vs actual timing of PPC for children with cancer and for identification of barriers to PPC integration. Descriptive statistics were used to summarize the data. For secondary analyses, a comparison of the associations of previous palliative care training with physician specialty was performed using the Pearson χ2 test or the Fisher exact test. The McNemar test was used to assess responses regarding the actual vs ideal timing of PPC consultation. Analysis of variance was used to compare mean values for perceived barriers by country income level. Answers to open-ended questions were analyzed qualitatively.ResultsA total of 831 physicians (578 women [69.6%]; 275 physicians [33.1%] aged &lt;35 years and 556 physicians [66.9%] aged ≥35 years) from 17 countries participated, with an overall response rate of 37.9% (831 of 2193) and a median country response rate of 51.4% (range, 22.2%-88.9%). Most respondents (572 [68.8%]) said that PPC should be involved from diagnosis, but only 117 (14.1%) stated that this occurred at their institution (P &lt; .001). The most significantly ranked barriers to PPC were lack of home-based services (713 [85.8%]), personnel (654 [78.7%]), and knowledge about PPC (693 [83.4%]), along with physician (676 [81.3%]) and family (603 [72.6%]) discomfort about PPC involvement. In addition, these barriers were rated as more important in lower-middle income countries compared with upper-middle income countries and high-income countries.Conclusions and RelevanceThis study highlights the discrepancy between ideal and actual timing of PPC for children with cancer and barriers to early PPC integration in Latin America. Interventions addressing access to PPC resources, didactic training, and clinical education (with a particular focus on equitable access to basic resources and support) are critical to improve the timing and quality of PPC in the region.

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Ethical Decision Making About End-of-life Care Issues by Pediatric Oncologists in Economically Diverse Settings

Abstract: Further education on ethical principles is warranted in pediatric oncology, particularly among oncologists practicing in low-income or middle-income countries.

Cited by 8 publications

References 11 publications

A multicountry assessment in Eurasia: Alignment of physician perspectives on palliative care integration in pediatric oncology with World Health Organization guidelines

A multicountry assessment in Eurasia: Alignment of physician perspectives on palliative care integration in pediatric oncology with World Health Organization guidelines

Physician Perceptions of Palliative Care for Children With Cancer in Latin America

Ideal vs Actual Timing of Palliative Care Integration for Children With Cancer in Latin America

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