1
|
Johnston EE, Rosenberg AR. Palliative Care in Adolescents and Young Adults With Cancer. J Clin Oncol 2024; 42:755-763. [PMID: 37862672 DOI: 10.1200/jco.23.00709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/27/2023] [Accepted: 08/25/2023] [Indexed: 10/22/2023] Open
Abstract
Palliative care (PC) aims to improve quality of life (QOL) for patients with serious illness and their families by recognizing and alleviating the physical, emotional, social, existential, and spiritual suffering of patients and their communities. Because adolescents and young adults (AYAs, age 15-39 years) with cancer commonly report distress across all these domains and because that distress translates to their QOL during and after their cancers, PC is particularly relevant for this population. Here, we review the evidence for PC among AYAs with cancer, including its rationale, gaps, opportunities, and implications for care delivery. For example, nearly 90% of AYAs with cancer report distressing symptoms during their treatment, those who survive report ongoing unmet psychosocial and physical health needs, and those who die from their cancers are highly likely to receive medically intense care that is discordant with their goals and values. AYA communication and decision making can be challenging because of ethical and developmental considerations regarding the patient's autonomy and competing priorities of patients and caregivers. PC interventions (including primary PC delivered by oncologists, routine PC subspecialty care, symptom tracking, advance care planning, and psychosocial programs promoting AYA resilience) are all associated with improved patient-centered outcomes. However, PC is inconsistently integrated into AYA oncology care, and access to PC programs is not equitable; marginalized groups continue to experience poorer outcomes. Ongoing and future research and clinical initiatives must continue to bridge these gaps. Improving the QOL of AYAs with cancer is a shared goal of the larger clinical oncology community, and including PC in AYA cancer care delivery can help attain that goal.
Collapse
Affiliation(s)
- Emily E Johnston
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
- Pediatric Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Department of Pediatrics, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| |
Collapse
|
2
|
Moreira DC, Metzger ML, Antillón-Klussmann F, González-Ramella O, Gao Y, Bazzeh F, Middlekauff J, Fox Irwin L, Gonzalez ML, Chantada G, Barr RD, Garrington T, Hastings C, Kutluk T, Saab R, Khan MS, Saha V, Rodríguez-Galindo C, Friedrich P. Development of EPAT: An assessment tool for pediatric hematology/oncology training programs. Cancer 2023; 129:3448-3456. [PMID: 37417913 DOI: 10.1002/cncr.34946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/18/2023] [Accepted: 05/28/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE In the absence of a standardized tool to assess the quality of pediatric hematology/oncology training programs, the Education Program Assessment Tool (EPAT) was conceptualized as a user-friendly and adaptable tool to evaluate and identify areas of opportunity, pinpoint needed modifications, and monitor progress for training programs around the world. METHODS The development of EPAT consisted of three main phases: operationalization, consensus, and piloting. After each phase, the tool was iteratively modified based on feedback to improve its relevance, usability, and clarity. RESULTS The operationalization process led to the development of 10 domains with associated assessment questions. The two-step consensus phase included an internal consensus phase to validate the domains and a subsequent external consensus phase to refine the domains and overall function of the tool. EPAT domains for programmatic evaluation are hospital infrastructure, patient care, education infrastructure, program basics, clinical exposure, theory, research, evaluation, educational culture, and graduate impact. EPAT was piloted in five training programs in five countries, representing diverse medical training and patient care contexts for proper validation of the tool. Face validity was confirmed by a correlation between the perceived and calculated scores for each domain (r = 0.78, p < .0001). CONCLUSIONS EPAT was developed following a systematic approach, ultimately leading to a relevant tool to evaluate the different core elements of pediatric hematology/oncology training programs across the world. With EPAT, programs will have a tool to quantitatively evaluate their training, allowing for benchmarking with centers at the local, regional, and international level.
Collapse
Affiliation(s)
| | | | - Federico Antillón-Klussmann
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
- Universidad Francisco Marroquin, Guatemala City, Guatemala
| | | | - Yijin Gao
- Shanghai Children's Medical Center, Shanghai, China
| | | | | | | | | | - Guillermo Chantada
- Fundacion Pérez Scremini-Hospital Pereira Rossell, Montevideo, Uruguay
- Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ronald D Barr
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | | | | | - Tezer Kutluk
- Hacettepe University Faculty of Medicine & Cancer Institute, Ankara, Turkey
| | - Raya Saab
- Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Muhammad Saghir Khan
- King Faisal Specialist Hospital and Research Center, Al Madinah Al Munawarrah, Saudi Arabia
| | | | | | - Paola Friedrich
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| |
Collapse
|
3
|
Lacerda A, Martínez MA, Dumont B, Leiss U, Kokkinou G, Scheinemann K, Craig F. Embracing paediatric palliative care in paediatric oncology from diagnosis onwards. Pediatr Blood Cancer 2023; 70:e30561. [PMID: 37430425 DOI: 10.1002/pbc.30561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/13/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
Paediatric palliative care aims to support children and young people with life-limiting or life-threatening conditions, and their families, from the time of diagnosis. Early integration within oncology has been recognised as having benefits for all involved, whatever the outcome may be. Through improved communication and advance care planning, it enables user-centred care, where concerns about quality of life, preferences and values are given the same relevance as cutting-edge therapy. Challenges to the integration of palliative care within paediatric oncology include raising awareness and providing education, whilst searching for the best care model and adapting to an ever-changing therapeutic scenario.
Collapse
Affiliation(s)
- Ana Lacerda
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- European Association for Palliative Care Children and Young People Reference Group, Vilvoorde, Belgium
- Department of Paediatrics, Portuguese Institute of Oncology, Lisbon, Portugal
| | - María Avilés Martínez
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Paediatric Palliative Care Unit, Niño Jesús Children's University Hospital, Madrid, Spain
- Department of Nursing, Autonomous University of Madrid, Madrid, Spain
| | - Benoît Dumont
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Paediatric Hematology and Oncology Institute, Léon Bérard Cancer Center, Lyon, France
| | - Ulrike Leiss
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Georgia Kokkinou
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Floga - Parents Association of Children with Cancer, Athens, Greece
- Childhood Cancer International Europe, Vienna, Austria
| | - Katrin Scheinemann
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- Division of Oncology-Haematology, Department of Paediatrics, Kantonsspital Aarau, Aarau, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Paediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Finella Craig
- SIOP Europe Palliative Care Working Group Steering Committee, Brussels, Belgium
- European Association for Palliative Care Children and Young People Reference Group, Vilvoorde, Belgium
- Louis Dundas Paediatric Palliative Care Centre, Great Ormond Street Hospital, London, UK
| |
Collapse
|
4
|
McNeil MJ, Godfrey A, Loggetto P, de Oliveira Junior A, Job G, Boldrini E, Regina Costa Murra G, Antunes Geronutti Ayub D, Francisco Oliveira de Lima A, Esmeraldo Andrade de Almeida A, Lopes Garcia J, Beatriz Costa Neves do Amaral A, Cristina Cunha Ferreira e Fonseca I, Friedrich P, Metzger ML, Devidas M, Agulnik A, Baker JN. Physician Perceptions of and Barriers to Pediatric Palliative Care for Children With Cancer in Brazil. JCO Glob Oncol 2023; 9:e2300057. [PMID: 37535886 PMCID: PMC10581636 DOI: 10.1200/go.23.00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/02/2023] [Accepted: 06/13/2023] [Indexed: 08/05/2023] Open
Abstract
PURPOSE Early integration of pediatric palliative care (PPC) for children with cancer is critical to improving the quality of life of both the patient and family. Understanding physician perceptions of palliative care and perceived barriers to early integration is necessary to develop PPC in Brazil. METHODS The Assessing Doctors' Attitudes on Palliative Treatment survey was modified for use in Brazil. The survey was open from January 2022 to June 2022 and distributed to physicians of all specialties from participating institutions who treat children with cancer. Statistical analysis was complemented by qualitative analysis of open-ended responses. RESULTS A total of 272 respondents participated. Most respondents reported access to PPC experts for consultation (77.2%) and 34.5% indicated previous palliative care training. Physician knowledge of PPC was generally aligned with WHO guidance (median alignment, 93.0%; range, 80.5%-98.2%). However, about half (53.3%) felt comfortable addressing physical needs of patients receiving PPC, 35.3% addressing emotional needs, 25.8% addressing spiritual needs, and 33.5% addressing grief and bereavement needs. Most respondents (65.4%) felt palliative care should be involved from diagnosis, but only 10.3% stated that this occurred in their setting. The most important barriers identified were physician discomfort (89.0%), limited physician knowledge (88.6%), and lack of home-based services (83.8%). CONCLUSION Despite a strong understanding of the role of palliative care, physicians in Brazil reported low confidence delivering PPC to children with cancer. Additionally, physicians generally believed that PPC should be integrated earlier in the disease trajectory of children with cancer. This work will direct educational and capacity building initiatives to ensure greater access to high-quality PPC for children with cancer in Brazil to address patient and family suffering.
Collapse
Affiliation(s)
- Michael J. McNeil
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | | | - Patricia Loggetto
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | | | - Godwin Job
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Erica Boldrini
- Hospital de Câncer Infantojuvenil de Barretos, Barretos, Brazil
| | | | | | | | | | - Julia Lopes Garcia
- Instituto de Tratamento do Câncer Infantil, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Paola Friedrich
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | | | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Justin N. Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| |
Collapse
|
5
|
Garcia-Quintero X, Cleves D, Cuervo MI, McNeil M, Salek M, Robertson EG, Gomez W, Baker JN, Kaye EC. Communication of Early Integration of Palliative Care for Children With Cancer in Latin America: The Care as a Vessel Metaphor. JCO Glob Oncol 2023; 9:e2200281. [PMID: 36595733 PMCID: PMC10166418 DOI: 10.1200/go.22.00281] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
| | - Daniela Cleves
- Department of Pediatrics, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Michael McNeil
- Department of Global Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Marta Salek
- Department of Global Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Eden G Robertson
- Department of Global Medicine, St Jude Children's Research Hospital, Memphis, TN.,Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Wendy Gomez
- Oncology Unit, Dr Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic
| | - Justin N Baker
- Department of Global Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Erica C Kaye
- Department of Global Medicine, St Jude Children's Research Hospital, Memphis, TN
| |
Collapse
|
6
|
McNeil MJ, Ehrlich B, Yakimkova T, Wang H, Mishkova V, Bezler Z, Kumirova E, Madni A, Movsisyan N, Williams K, Baizakova B, Borisevich M, Chatman G, Erimbetova I, Quintero XG, Golban R, Kirby B, Nunez P, Ranadive R, Sakhar N, Sonnenfelt J, Volkova A, Moreira D, Friedrichsdorf SJ, Wolfe J, Remke S, Hauser J, Devidas M, Baker JN, Agulnik A. Regional adaptation of the education in palliative and end-of-life Care Pediatrics (EPEC-Pediatrics) curriculum in Eurasia. Cancer Med 2022; 12:3657-3669. [PMID: 36073348 PMCID: PMC9939085 DOI: 10.1002/cam4.5213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/14/2022] [Accepted: 08/24/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Pediatric palliative care (PPC) is a priority to improve pediatric hematology oncology (PHO) care in Eurasia. However, there are limited regional opportunities for PPC education. We describe the adaptation and implementation of a bilingual end-user Education in Palliative and End-of-Life Care (EPEC)-Pediatrics course for PHO clinicians in Eurasia. METHODS Due to COVID-19, this course was delivered virtually, consisting of prerecorded, asynchronous lectures, and a bilingual workshop with interactive lectures and small group sessions. A pre-postcourse design was used to evaluate the knowledge acquisition of the participants including their knowledge alignment with World Health Organization (WHO) guidance, ideal timing of palliative care, and comfort in providing palliative care to their patients. Questions were mostly quantitative with multiple choice or Likert scale options, supplemented by free-text responses. RESULTS A total of 44 (76%) participants from 14 countries completed all components of the course including pre- and postcourse assessments. Participant alignment with WHO guidance improved from 75% in the pre- to 90% in the postcourse assessments (p < 0.001). After participation, 93% felt more confident controlling the suffering of children at the end of life, 91% felt more confident in prescribing opioids and managing pain, and 98% better understood how to hold difficult conversations with patients and families. Most participants (98%) stated that they will change their clinical practice based on the skills and knowledge gained in this course. CONCLUSIONS We present a successful regional adaptation of the EPEC-Pediatrics curriculum, including novel delivery of course content via a virtual bilingual format. This course resulted in significant improvement in participant attitudes and knowledge of PPC along with an understanding of the ideal timing of palliative care consultation and comfort in providing PPC to children with cancer. We plan to incorporate participant feedback to improve the course and repeat it annually to improve access to high-quality palliative care education for PHO clinicians in Eurasia.
Collapse
Affiliation(s)
| | - Bella Ehrlich
- St. Jude Children's Research HospitalMemphisTennesseeUSA,Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | | | - Huiqi Wang
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Volha Mishkova
- Belarusian Research Center for Pediatric OncologyHematology and ImmunologyMinskBelarus
| | - Zhanna Bezler
- Belarusian Clinical Center of Palliative Care for ChildrenMinskBelarus
| | - Ella Kumirova
- Dmitry Rogachev National Research Center of Pediatric HematologyOncology and ImmunologyMoscowRussia,Russian Scientific Center of Roengenology and RadiologyMoscowRussia,Pyrogov Medical UniversityMoscowRussia,Morozovskaya Children's City Clinical HospitalMoscowRussia,N.N. Blokhin National Medical Research Center of OncologyMoscowRussia
| | - Arshia Madni
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Narine Movsisyan
- Yerevan State Medical University After Mkhitar HeratsiYerevanArmenia
| | - Karen Williams
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Baglan Baizakova
- George Washington UniversityThe Milken Institute School of Public HealthWashington, District of ColumbiaUSA
| | - Marina Borisevich
- Belarusian Research Center for Pediatric OncologyHematology and ImmunologyMinskBelarus
| | | | - Indira Erimbetova
- The Republican Center for Hematology and Blood TransfusionTashkentUzbekistan
| | | | - Rodica Golban
- Institute of Oncology of Republic of MoldovaMoldovaChisinau
| | - Brandi Kirby
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Paola Nunez
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | | | - Nadezhda Sakhar
- Republican Scientific and Practical Center for Pediatric SurgeryMinskBelarus
| | | | - Alisa Volkova
- Raisa Gorbacheva Memorial Research Institute for Pediatric OncologyHematology and TransplantationSt. PetersburgRussia
| | - Daniel Moreira
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| | | | - Joanne Wolfe
- Dana Farber Cancer InstituteBostonMassachusettsUSA
| | - Stacy Remke
- University of MinnesotaMinneapolisMinnesotaUSA
| | | | | | | | - Asya Agulnik
- St. Jude Children's Research HospitalMemphisTennesseeUSA
| |
Collapse
|
7
|
Attitudes and Practices of Pediatric Oncologists Regarding Palliative Care Consultation for Pediatric Oncology Patients. J Pediatr Hematol Oncol 2022; 44:230-236. [PMID: 35041359 DOI: 10.1097/mph.0000000000002276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We sought to describe palliative care services available to children with cancer along with pediatric oncologists' current and ideal practices of palliative care involvement in children with cancer. DESIGN A novel survey tool was administered via REDCap to attending pediatric oncologists in the United States. The survey remained open from June to September 2020. RESULTS A total of 265 survey responses were evaluated. Most respondents endorsed that palliative care should "always" be consulted for the following scenarios: new diagnosis of advanced/metastatic disease (53%), uncontrolled symptoms (65%), bone marrow transplant (55%), and relapsed/refractory disease (73%). For those same scenarios, the majority noted the current practice was to "sometimes" or "usually" consult. Most respondents (92.6%) felt that palliative care should be consulted more frequently than they were currently being consulted. CONCLUSIONS Compared with the current practice for various pediatric oncology departments, palliative care was not consulted as often as oncologists desired. While barriers to palliative care consultation are outlined in the literature, exploration of how to address them as well as identification of barriers specific to oncologists who are in favor of palliative care consultation are not well-described. Further research exploring these specific barriers is necessary to understand the disconnect between oncologists' attitudes and palliative care consultation.
Collapse
|
8
|
Ehrlich BS, Yakimkova T, Batmunkh T, Mishkova V, Movsisyan N, Kirgizov K, Borisevich M, Kizyma R, Graetz DE, McNeil MJ, Vinitsky A, Smelov V, Corbex M, Lam CG, Kaye EC, Baker JN, Agulnik A. Translating Research to Action: The Development of a Pediatric Palliative Cancer Care Advocacy Tool in Eurasia. JCO Glob Oncol 2022; 8:e2100270. [PMID: 35084997 PMCID: PMC8806380 DOI: 10.1200/go.21.00270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Assessing Doctors' Attitudes on Palliative Treatment study was conducted in 11 Eurasian countries to assess physician knowledge of and structural barriers to integration of palliative care into pediatric oncology. After publication, regional collaborators identified the need to disseminate country-specific study results locally and provide policy recommendations to inform stakeholders. Translating research to action has never been more important in the field of global pediatric palliative oncology. ![]()
Collapse
Affiliation(s)
| | | | | | - Volha Mishkova
- Belarussian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Narine Movsisyan
- Anesthesiology and Intensive Care, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia
| | - Kirill Kirgizov
- N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia
| | - Marina Borisevich
- Belarussian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Roman Kizyma
- Western Ukrainian Specialized Children's Medical Centre, Lviv, Ukraine
| | | | | | | | - Vitaly Smelov
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Marilys Corbex
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | - Erica C Kaye
- St Jude Children's Research Hospital, Memphis, TN
| | | | - Asya Agulnik
- St Jude Children's Research Hospital, Memphis, TN
| |
Collapse
|
9
|
Ehrlich BS, Movsisyan N, Batmunkh T, Kumirova E, Borisevich MV, Kirgizov K, Graetz DE, McNeil MJ, Yakimkova T, Vinitsky A, Ferrara G, Li C, Lu Z, Kaye EC, Baker JN, Agulnik A. Barriers to the early integration of palliative care in pediatric oncology in 11 Eurasian countries. Cancer 2020; 126:4984-4993. [PMID: 32813913 DOI: 10.1002/cncr.33151] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/03/2020] [Accepted: 07/13/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND The early integration of palliative care significantly improves quality of life for children with cancer. However, cultural, structural, and socioeconomic barriers can delay the integration of palliative care into cancer care, particularly in low-income and middle-income countries. To date, little is known regarding the timing of and barriers to palliative care integration in Eurasia. METHODS The Assessing Doctors' Attitudes on Palliative Treatment (ADAPT) survey evaluates physician perceptions regarding palliative care integration into pediatric oncology in Eurasia. This evidence-based survey was adapted to the regional context; iteratively reviewed by US and regional panelists; and piloted in English, Russian, and Mongolian. After distribution to physicians caring for children with cancer, statistical analysis was complemented by qualitative analysis of open-ended responses. RESULTS A total of 424 physician responses were received from 11 countries in the Eurasian region. Study findings demonstrated wide variability in access to palliative care experts across countries (18%-96%), with the majority of providers (64%) reporting that the initial palliative care consultation typically occurs when curative options are no longer available. Providers desired an earlier initial palliative care consultation than what currently occurs in their setting (P < .001). Primary barriers to timely consultation included limited access to palliative care services and specialists, lack of physician education, and perceived family resistance. CONCLUSIONS The current study is the first to identify physician perceptions of the delayed timing of palliative care integration into childhood cancer care and associated barriers in Eurasia. These findings will inform the development of targeted interventions to mitigate local structural and cultural barriers to access and facilitate earlier palliative care integration in the region.
Collapse
Affiliation(s)
- Bella S Ehrlich
- Warren Alpert Medical School, Brown University, Providence, Rhode Island.,Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Narine Movsisyan
- Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | | | - Ella Kumirova
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Marina V Borisevich
- Belarusian Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | | | - Dylan E Graetz
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Michael J McNeil
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Taisiya Yakimkova
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Anna Vinitsky
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gia Ferrara
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Chen Li
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhaohua Lu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Erica C Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | |
Collapse
|