title: Barriers of healthcare providers against end-of-life discussions with pediatric cancer patients.
abstract: OBJECTIVE
  End-of-life discussions with patients can be one of the most difficult and stressful tasks for the oncologist. However, little is known about the discussions that healthcare providers have with patients in such situations and the difficulties they face. The primary end points of this study were to describe the contents of end-of-life discussion in the pediatric setting and the barriers to end-of-life discussion for pediatric patients, as perceived by pediatric healthcare providers.
  
  
  METHODS
  Participants were 10 healthcare providers. Semi-structured interviews were conducted, and the KJ method was performed to analyze the data.
  
  
  RESULTS
  We found 23 barriers against end-of-life discussion with pediatric cancer patients. These barriers were classified as follows: healthcare provider factors, patient factors, parent factors and institutional or cultural factors. In addition to barriers found in previous studies, some unique barriers were uncovered such as, 'Lack of confidence to face the patient after the discussion', 'Uncertain responsibility for treatment decision-making' and 'No compelling reason to discuss'. Healthcare providers actively discussed the purpose of treatment and the patients' wishes and concerns; however, they were reluctant to deal with the patients' own impending death and their estimated prognosis.
  
  
  CONCLUSIONS
  End-of-life discussion with pediatric patients differs from that with adult patients. Further studies are required to analyze pediatric cases associated with end-of-life discussion and carefully discuss its adequacy, pros and cons.
authors.affiliation: Center for Cancer Control and Information Services, National Cancer Center, Tokyo Department of Psycho-oncology, National Cancer Center Hospital, Tokyo, Japan saryoshi@ncc.go.jp.
authors.forename: Saran
authors.initials: S
authors.lastname: Yoshida
authors.affiliation: Department of Psycho-oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Shimizu
authors.affiliation: Department of Psycho-oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Psycho-oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Inoguchi
authors.affiliation: Department of Psycho-oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Oshima
authors.affiliation: Department of Psycho-oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Chikako
authors.initials: C
authors.lastname: Dotani
authors.affiliation: Department of Psycho-oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Rika
authors.initials: R
authors.lastname: Nakahara
authors.affiliation: Department of Psycho-oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Center for Cancer Control and Information Services, National Cancer Center, Tokyo Department of Psycho-oncology, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kato
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D002648:Child; D003657:Decision Making; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D010372:Pediatrics; D013727:Terminal Care
keywords: barrier; end-of-life discussion; pediatric cancer; qualitative study