Parental and Medical Professional Opinions on Paediatric Palliative Care for Cancer
CMAJ, the Canadian Medical Association Journal, published an article by a number of researchers, many from the paediatric oncology and hematology department at the Hospital for Sick Children (SickKids) in Toronto, Ontario. The article is titled, “Chemotherapy versus supportive care alone in pediatric palliative care for cancer: comparing the preferences of parents and health care professionals “. It is freely available online from CMAJ.
The research conducted for this article focuses on the differences in opinions between parents and health care professionals when a child suffering from cancer is in the final stages of their disease and cure is highly unlikely. Specifically, whether to proceed with treatment (palliative chemotherapy) or to provide the child with comfort from their symptoms (supportive care). Interviews were conducted with 77 families who had children suffering from cancer that did not have a reasonable chance of survival.
The interviews revealed a significant difference of opinion between parents and medical professionals during the end stages of a child’s care when suffering from cancer. 54.5% of parents supported the approach of palliative chemotherapy, at strong contrast to only 15.6% of medical professionals who would recommend continuing some form of treatment. Understandably, the factors affecting the parents decision to continue treatment were hope, quality of life, and survival time (Tomlinson et al, 2011, pg. 4).
“We found that parents and health care professionals make similar considerations during end-of-life decision-making. However, parents alsofocus on the importance of hope; this factor may loom larger for parents than for health care professionals. Given their relatively scant experience with the outcomes of similar children, parents may focus more on hope for their child compared with health care professionals, who are more aware of eventual outcomes given their experiences with many similar children. Health care professionals, as a group, tended to regard supportive care alone more positively than did parents, implying that parents and health care professionals generally have different underlying attitudes toward end-of-life treatments. These underlying differences may, in part, contribute to the apparent conflict between professionals and parents when tensions emerge during the palliative phase of care” (Tomlinson et al., 2001, pps. 4-6).
Tomlinson, D., Bartels, U., Gammon, J., Hinds, P.S., Volpe, J., Bouffet, E., Regier, D.A., Baruchel, S., Greenberg, M., Barrera, M., Llewellyn-Thomas, H., Sung, L. (2011) Chemotherapy versus supportive care alone in pediatric palliative care for cancer: comparing the preferences of parents and health care professionals. CMAJ, published online October 17, 2011. http://www.cmaj.ca/content/early/2011/10/17/cmaj.110392.full.pdf+html