title: Factors affecting treatment choices in paediatric palliative care: comparing parents and health professionals.
abstract: OBJECTIVE
  When children with cancer are no longer curable, parents often need to decide between further aggressive treatments or symptom relief alone. Objectives were to: (1) Describe and compare factors influencing parent and healthcare professional (HCP) decision-making regarding the choice between chemotherapy versus supportive care alone in paediatric palliative care; and (2) Describe how these factors influence this choice.
  
  
  METHODS
  Participants included parents of children with cancer without a reasonable chance of cure and health care professionals in paediatric oncology. Respondents were asked to indicate the preferred option and to report what factors affected their choice. Each factor was then rated on an importance visual analogue scale (VAS) ranging from 0 to 10. The importance scales were compared between parents and HCPs and the influence of importance ratings on preferred option was examined.
  
  
  RESULTS
  A total of 77 parents and 128 health care professionals participated. For parents the median importance scores for hope, increased survival time and child quality of life were rated as most important (VAS score=10). Parents rated these factors to be significantly more important than HCPs. Conversely, HCPs rated financial considerations more important than parents. For HCPs, stronger importance ranking for parent opinion was associated with stronger preference for aggressive chemotherapy.
  
  
  CONCLUSIONS
  Hope, increased survival time and child quality of life are all more important factors to parents when decision-making at end-of-life compared to HCPs. Conversely, HCPs place greater emphasis on the families' financial considerations than parents. Understanding these differences may aid in communication and improve end-of-life care for children with cancer.
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
authors.forename: Deborah
authors.initials: D
authors.lastname: Tomlinson
authors.forename: Ute
authors.initials: U
authors.lastname: Bartels
authors.forename: Eleanor
authors.initials: E
authors.lastname: Hendershot
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Maloney
authors.forename: Marie-Chantal
authors.initials: MC
authors.lastname: Ethier
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D017028:Caregivers / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D003657:Decision Making; D004358:Drug Therapy / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000451:nursing / Q000523:psychology / Q000628:therapy*; D010166:Palliative Care / Q000523:psychology*; D013727:Terminal Care / Q000523:psychology
chemical_list: D000970:Antineoplastic Agents