Parents less likely to choose supportive care
Aggressive therapy perceived as hope
Parents are more likely to choose aggressive chemotherapy for their children who are in the palliative stage of cancer than the health care professionals caring for the children, according to a study published in the Canadian Medical Association Journal.1
A total of 77 parents and 128 health care professionals participated in the study, which compared the strength of parental and health care professionals' preferences. Important factors influencing the decision between therapeutic options were child quality of life and survival time among both parents and health care professionals. Hope was particularly important to parents. Parents significantly favored chemotherapy (54.5%) compared with health care professionals (15.6%).
Researchers included parents of children whose cancer had no reasonable chance of being cured and health care professionals in pediatric oncology in the study. Separate interviews were administered to all participants. Visual analogue scales were shown to respondents to illustrate the anticipated level of the child's quality of life and the expected duration of survival. Health care professionals were also shown a scale to illustrate the probability of cure. Respondents were then asked which treatment option they would favor given these baseline attributes. In addition, respondents reported what factors might affect such a decision and ranked all factors identified in order of importance.
Despite the high importance ranking parents assign to their child's quality of life, parents reported that they would accept chemotherapy even if it reduced both quality of life and survival time. This finding shows the complexity of decision-making and the researchers suggest that "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."
1. Tomlinson D, Bartels U, Gammon J, et al. Chemotherapy versus supportive care alone in pediatric palliative care for cancer: Comparing the preferences of parents and health care professionals. CMAJ 2011 Oct 17; Epub ahead of print.