Attitudes and practices among pediatric oncologists regarding end-of-life care: results of the 1998 American Society of Clinical Oncology survey.
OBJECTIVE
In 1998, the American Society of Clinical Oncology (ASCO) surveyed its membership to assess the attitudes, practices, and challenges associated with end-of-life care of patients with cancer. In this report, we summarize the responses of pediatric oncologists and the implications for care of children dying from cancer.


METHODS
The survey consisted of 118 questions, covering eight categories. All ASCO members in the United States, Canada, and the United Kingdom were mailed a survey, which was completed by 228 pediatric oncologists. Predictors of particular attitudes and practices were identified using stepwise logistic regression analysis. Potential predictors were age, sex, religious affiliation, importance of religious beliefs, recent death of a relative, specialty, type of practice (rural or urban, academic or nonacademic), amount of time spent in patient care, number of new patients in the past 6 months, and number of patients who died in the past year.


RESULTS
Pediatric oncologists reported a lack of formal courses in pediatric palliative care, a strikingly high reliance on trial and error in learning to care for dying children, and a need for strong role models in this area. The lack of an accessible palliative care team or pain service was often identified as a barrier to good care. Communication difficulties exist between parents and oncologists, especially regarding the shift to end-of-life care and adequate pain control.


CONCLUSIONS
Pediatric oncologists are working to integrate symptom control, psychosocial support, and palliative care into the routine care of the seriously ill child, although barriers exist that make such comprehensive care a challenge.
Hilden
J M
JM
Department of Pediatric Hematology/Oncology, Children's Hospitals and Clinics--St Paul, St Paul, MN 55102, USA. hilde005@tc.umn.edu
Emanuel
E J
EJ
Fairclough
D L
DL
Link
M P
MP
Foley
K M
KM
Clarridge
B C
BC
Schnipper
L E
LE
Mayer
R J
RJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002170:Canada; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003657:Decision Making; D005065:Euthanasia; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008495:Medical Oncology / Q000193:education; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D017236:Suicide, Assisted; D013727:Terminal Care / Q000592:standards*; D006113:United Kingdom; D014481:United States