title: Considerations about hastening death among parents of children who die of cancer.
abstract: OBJECTIVE
  To estimate the frequency of hastening death discussions, describe current parental endorsement of hastening death and intensive symptom management, and explore whether children's pain influences these views in a sample of parents whose child died of cancer.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Two tertiary-care US pediatric institutions.
  
  
  METHODS
  A total of 141 parents of children who died of cancer (response rate, 64%).
  
  
  METHODS
  Proportion of parents who (1) considered or (2) discussed hastening death during the child's end of life and who endorsed (3) hastening death or (4) intensive symptom management in vignettes portraying children with end-stage cancer.
  
  
  RESULTS
  A total of 19 of 141 (13%; 95% confidence interval [CI], 8%-19%) parents considered requesting hastened death for their child and 9% (95% CI, 4%-14%) discussed hastening death; consideration of hastening death tended to increase with an increase in the child's suffering from pain. In retrospect, 34% (95% CI, 26%-42%) of parents reported that they would have considered hastening their child's death had the child been in uncontrollable pain, while 15% or less would consider hastening death for nonphysical suffering. In response to vignettes, 50% (95% CI, 42%-58%) of parents endorsed hastening death while 94% (95% CI, 90%-98%) endorsed intensive pain management. Parents were more likely to endorse hastening death if the vignette involved a child in pain compared with coma (odds ratio, 1.4; 95% CI, 1.1-1.8).
  
  
  CONCLUSIONS
  More than 10% of parents considered hastening their child's death; this was more likely if the child was in pain. Attention to pain and suffering and education about intensive symptom management may mitigate consideration of hastening death among parents of children with cancer.
authors.affiliation: Center for Outcomes and Policy Research and Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, 44 Binney St., Boston, MA 02115, USA. joanne_wolfe@dfci.harvard.edu
authors.forename: Veronica
authors.initials: V
authors.lastname: Dussel
authors.forename: Steven
authors.initials: S
authors.lastname: Joffe
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Hilden
authors.forename: Jan
authors.initials: J
authors.lastname: Watterson-Schaeffer
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
authors.forename: Joanne
authors.initials: J
authors.lastname: Wolfe
mesh_terms: D000328:Adult; D001293:Attitude to Death; D001900:Boston / Q000453:epidemiology; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D028601:Euthanasia, Active / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D010146:Pain / Q000453:epidemiology; D010290:Parents; D012189:Retrospective Studies; D012959:Socioeconomic Factors