title: Family Refusal of Chemotherapy for Pediatric Cancer Patients: A National Survey of Oncologists.
abstract: BACKGROUND
  Refusal of therapy is ethically acceptable for competent adults. Practitioner opinions regarding refusal of therapy in pediatric cancer patients has not been widely studied. This is the largest survey of oncology practitioners assessing support for refusal of chemotherapy.
  
  
  METHODS
  Pediatric oncology nurses/physicians were asked: "As their provider I would support refusal of chemotherapy by a family," with the following options: "Never support refusal," "Always support refusal," or "Support for refusal would depend on cure rate, age, or both." Variables assessed were: age (0 to 7, 8 to 13, 14 to 17 y) and cure rate (0% to 33%, 34% to 66%, 67% to 100%).
  
  
  RESULTS
  A total of 957 practitioners responded. Fifty-six percent, 31%, and 0.2%, respectively, stated their support of chemotherapy refusal depended on "age and cure rate," "cure rate alone," or "age alone." Two percent and 11% indicated they would "always" or "never" support refusal, respectively. For a "modest" or "good" cure rate, support for refusal was <20%, whereas for a "poor" cure rate, the majority would support a family's refusal (53% to 78% age dependent). Within each cure rate, respondents were more likely to support refusal for older patients (P<0.001).
  
  
  CONCLUSIONS
  The majority of practitioners surveyed viewed parental refusal of chemotherapy for children with a moderate or good expected cure rate as unacceptable, but were more accepting of refusal with a poor prognosis, especially for teenagers.
authors.affiliation: *Department of Pediatrics, Rush University Medical Center †Department of Pediatrics, Section of Hematology/Oncology, University of Chicago §University of Chicago Medical School, Chicago, IL ‡Department of Pediatrics, University of Michigan, Ann Arbor, MI.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Nassin
authors.forename: Emily L
authors.initials: EL
authors.lastname: Mueller
authors.forename: Curt
authors.initials: C
authors.lastname: Ginder
authors.forename: Paul M
authors.initials: PM
authors.lastname: Kent
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002648:Child; D003625:Data Collection; D005260:Female; D006801:Humans; D008495:Medical Oncology / Q000706:statistics & numerical data*; D009369:Neoplasms / Q000188:drug therapy*; D009726:Nurses / Q000706:statistics & numerical data; D010372:Pediatrics / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D016312:Treatment Refusal / Q000706:statistics & numerical data
chemical_list: D000970:Antineoplastic Agents