title: Health-care providers' perspectives on childhood cancer treatment in Manado, Indonesia.
abstract: BACKGROUND
  Childhood cancer survival in low-income countries is low.
  
  
  OBJECTIVE
  Our study investigated health-care providers' perspectives on childhood cancer treatment in Indonesia. Their health beliefs and attitudes toward parental financial difficulties, protocol adherence, parental education, and communication were explored.
  
  
  METHODS
  A self-administered questionnaire was filled in by 222 health-care providers (156 doctors, 51 nurses, 6 social workers, 9 administrators)
  
  
  RESULTS
  Health of children with cancer is beyond doctor's control and determined by luck, fate or God according to 35% of health-care providers, 30% were uncertain about this statement, and 35% disagreed. Combination of chemotherapy and alternative treatment is best to achieve cure according to 15% of health-care providers, 50% were uncertain, and 35% disagreed. Prosperous parents adhere better with treatment (67%). Doctors adhere better with cancer treatment for prosperous patients (55%). When dealing with poor families, less elaborate explanation is given (62%), more difficult vocabulary is used (49%), and less cooperation is offered (46%). Reasons for non-adherence with treatment protocol were as follows: financial difficulties parents (82%), side-effects (77%), lack of motivation parents (75%), and inadequate drugs supply at pharmacy (70%). Information about cancer and treatment makes parents more afraid or depressed about future, and parents prefer not to know according to 27% of health-care providers, 20% were uncertain, and 53% disagreed. Communication with parents is hindered by differences in status and social hierarchical structures (83%).
  
  
  CONCLUSIONS
  Health-care providers' beliefs about childhood cancer treatment are characterized by much uncertainty and contradiction. This likely affects adherence of health-care providers, parents, and childhood cancer treatment outcome.
authors.affiliation: Department of Pediatric Oncology-Hematology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Mostert
authors.forename: S
authors.initials: S
authors.lastname: Gunawan
authors.forename: J A P
authors.initials: JA
authors.lastname: van Dongen
authors.forename: P M
authors.initials: PM
authors.lastname: van de Ven
authors.forename: M N
authors.initials: MN
authors.lastname: Sitaresmi
authors.forename: E E
authors.initials: EE
authors.lastname: Wolters
authors.forename: A J P
authors.initials: AJ
authors.lastname: Veerman
authors.forename: M
authors.initials: M
authors.lastname: Mantik
authors.forename: G J L
authors.initials: GJ
authors.lastname: Kaspers
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D003430:Cross-Sectional Studies; D003469:Culture; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007214:Indonesia; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D010290:Parents / Q000523:psychology; D010372:Pediatrics; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: adherence; attitude; beliefs; childhood cancer; health-care providers; low-income countries