Publication
Decision-Making Factors in Advanced or Incurable Childhood Cancer Diagnosis in Low- and Middle- Income Countries
Rule A, Salek M · Journal of Pain and Symptom Management · 2024
Outcomes: 1. Using a structured approach, participants will self-report the ability to understand the static and dynamic factors that influence treatment decision-making at diagnosis for children presenting with advanced cancer in LMICs. 2. Participants will reflect on the need to revise and develop treatment guidelines that are adaptable to resource-constrained settings and consider challenges faced by physicians caring for children presenting with advanced cancer at diagnosis, considering also the need to explore decision-making approaches of other key decision-partners. Key Message: Physicians face challenging treatment decision-making for children presenting with advanced cancer in LMICs. In this study, we sought to understand approaches to decision-making and factors modifying treatment recommendations at diagnosis. Preliminary findings describe how decision-making can be influenced by dynamic factors and cure-directed treatment is not always offered. Revision of treatment guidelines considering challenges faced in these contexts is required. Introduction/Context: Physicians in low- and middle-income countries (LMICs) face challenging treatment decision-making for children presenting with advanced cancer. Decision-making in these circumstances has not been well described, and current treatment guidelines may not reflect challenges faced by physicians in LMICs. Objective(s): In this study, we sought to understand physician decision-making approaches and factors that modify treatment recommendations at diagnosis for these children in LMICs. Method(s): Semi-structured interviews were conducted with physicians who treat children diagnosed with cancer across six World Health Organization (WHO) defined regions. Interviews were conducted using an online platform, audio-recorded, and transcribed. The research team developed a hybrid inductive/deductive codebook utilizing an existing framework describing factors influencing treatment decision-making and applied codes across transcripts. Thematic content analysis focused on decision-making approaches. Result(s): Thirty-six physicians completed interviews. Preliminary analysis describes decision-making processes with initial treatment recommendations based on static factors considered for all patients, including the diagnosis and disease burden. Many physicians described their inability to offer cure-directed treatment at diagnosis. Treatment recommendations were modified at two points: 1) prior to and 2) during or after the discussion with the patient/family. Dynamic factors that altered an initial recommendation included resource and treatment availability and allocation, treatment affordability, and family alignment or disagreement with the treatment recommendation. Conclusion(s): Treatment decision-making for children presenting with advanced cancer in LMICs is not linear, and curative treatments cannot always be offered. Revision of treatment guidelines for use in resource-constrained settings which incorporate challenges faced and factors that modify decision-making in the context of advanced disease at diagnosis is required. Future work will explore the perspectives and decision-making approaches of patients/families to inform intervention design to support decision-making, including the provision of upfront non-curative treatment strategies and early integration of palliative care. This abstract was completed on behalf of the CATALYST Study Group. Keywords: Models of Palliative Care DeliveryGlobal Palliative CareCopyright © 2024
Synced from the TRENDS in Pediatric Palliative Care Zotero library, curated by The Siden Research Team. ICPCN does not host or verify the full text.