Factors affecting treatment choices in paediatric palliative care: comparing parents and health professionals

Abstract

Study aim: When children with cancer are no longer curable, parents often need to decide between further aggressive treatments or symptom relief alone. Objectives were to: (1) Describe and compare factors influencing parent and healthcare professional (HCP) decision-making regarding the choice between chemotherapy versus supportive care alone in paediatric palliative care; and (2) Describe how these factors influence this choice.

Methods: Participants included parents of children with cancer without a reasonable chance of cure and health care professionals in paediatric oncology. Respondents were asked to indicate the preferred option and to report what factors affected their choice. Each factor was then rated on an importance visual analogue scale (VAS) ranging from 0 to 10. The importance scales were compared between parents and HCPs and the influence of importance ratings on preferred option was examined.

Results: A total of 77 parents and 128 health care professionals participated. For parents the median importance scores for hope, increased survival time and child quality of life were rated as most important (VAS score=10). Parents rated these factors to be significantly more important than HCPs. Conversely, HCPs rated financial considerations more important than parents. For HCPs, stronger importance ranking for parent opinion was associated with stronger preference for aggressive chemotherapy.

Conclusion: Hope, increased survival time and child quality of life are all more important factors to parents when decision-making at end-of-life compared to HCPs. Conversely, HCPs place greater emphasis on the families' financial considerations than parents. Understanding these differences may aid in communication and improve end-of-life care for children with cancer.