Oncologists struggle to predict decisional preferences for minority parents more than they do for white parents, according to the authors of a recent survey of 365 parents of children with cancer and their oncologists.1

“This study was motivated by a desire to better understand the decision-making experiences of racial and ethnic minority parents in pediatric oncology,” says Jennifer W. Mack, MD, MPH, one of the study’s authors.

Previously, researchers had found that minority parents were more likely to regret treatment decisions for their children.2 “We were especially interested in whether the experiences they reported differed from experiences of white parents,” says Mack, co-director of the pediatric hematology/oncology fellowship program and associate professor of pediatrics at Harvard Medical School.

Oncologists accurately predicted parental preferences for 53% of white parents, 23% of black parents, 37% of Hispanic parents, and 43% of Asian/other race parents. Minority parents held more active roles than white parents. One-quarter of white parents reported parent-led decision-making, compared to 37% of black parents, 48% of Hispanic parents, and 56% of Asian/other race parents.

“We were surprised to find that minority parents were at risk for holding more active roles in decision-making than they really wanted,” Mack observes. The researchers interpreted this as minority parents feeling less well-supported by clinicians in their decisions. Previous work regarding adult patients and decision-making suggested that minority patients may be less involved than white patients in making decisions.3

“But our findings identified the opposite pattern,” Mack reports. Clinicians also were not as adept at recognizing parents’ preferred decisional roles for minority parents as they were for white parents. This could explain the mismatch between minority parents’ preferred and actual roles.

“We, therefore, worry that minority parents have less optimal experiences making decisions for their children,” Mack laments. The study’s findings suggest that clinicians partner with minority parents in these decisions less effectively than for white parents.

According to Mack, both clinicians and ethicists “need to be aware of the importance of developing a supportive partnership with all parents and supporting their desired roles in making decisions for their children.”

REFERENCES

  1. Sisk BA, Kang TI, Mack JW. Racial and ethnic differences in parental decision-making roles in pediatric oncology. J Palliat Med 2019; Aug 13. doi: 10.1089/jpm.2019.0178. [Epub ahead of print].
  2. Sisk BA, Kang TI, Mack JW. The evolution of regret: Decision-making for parents of children with cancer. Support Care Cancer 2019; Jun 20. doi: 10.1007/s00520-019-04933-8. [Epub ahead of print].
  3. Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender, and partnership in the patient-physician relationship. JAMA 1999;282:583-589.