Differences in pediatric oncologists' estimates of curability and treatment recommendations for patients with advanced cancer.
BACKGROUND
When goals of therapy for children with advanced cancer are called into question, physician recommendations regarding treatment goals have been shown to be important for families. However, there has been no demonstration of the degree of variation between pediatric oncologists' recommendations in such situations.


METHODS
We provided 48 pediatric oncologists with two identical case histories and identical prognostic data from the literature. Individual interviews were then performed to assess variation in (1) recommended treatment goal, (2) perceived chances for cure, and (3) degree to which further curative intervention would be considered desirable for each patient.


RESULTS
There was a large variability in each of the areas examined. For both patients, there was wide divergence (2:1 and 2:3) in whether to recommend cure as the goal of treatment. There were also differences in physician estimates for likelihood of cure for each patient. Finally, even among those with identical estimates for likelihood of cure, there were differences in the treatment goals physicians would recommend and how strongly they would counsel for them.


CONCLUSIONS
This study demonstrates that even with identical clinical data and prognostic evidence from the literature, pediatric oncologists vary widely in their recommendations regarding goals of treatment for children with advanced cancer.
Wusthoff
Courtney J
CJ
Department of Pediatrics, University of California, San Francisco, CA 94143, USA.
McMillan
Alex
A
Ablin
Arthur R
AR
D002648:Child; D003657:Decision Making; D019468:Disease Management; D006801:Humans; D008495:Medical Oncology; D009369:Neoplasms / Q000628:therapy*; D010347:Patient Care Planning; D010465:Perception; D010819:Physician's Role; D011379:Prognosis