title: Ethical decision making about end-of-life care issues by pediatric oncologists in economically diverse settings.
abstract: OBJECTIVE
  Pediatric cancer represents 1% to 4% of all cancers worldwide, with the majority of diagnoses in developing countries where mortality remains much higher than that in high-income countries. We sought to describe differences in ethical decision-making at the end of life among an international sample of pediatric oncologists practicing in countries with a variety of income levels and resource settings.
  
  
  METHODS
  Pediatric oncologists subscribing to an educational international oncology Web site were invited to complete a 38-item web-based survey investigating ethical domains related to end-of-life care: level of care, fiduciary responsibility, decision making, and justice.
  
  
  RESULTS
  Responses were received from 401 physicians in 83 countries, with most respondents practicing in middle-income or high-income countries. Significant differences in attitudes toward ethical issues existed across the national developmental indices.
  
  
  CONCLUSIONS
  Further education on ethical principles is warranted in pediatric oncology, particularly among oncologists practicing in low-income or middle-income countries.
authors.affiliation: *University of North Carolina at Chapel Hill, Chapel Hill §Duke University, Durham, NC ‡Texas A&M Health Science Center, Temple, TX †St Jude Children's Research Hospital, Memphis, TN ∥Arkansas Children's Hospital, Little Rock, AR.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Sanchez Varela
authors.forename: Liza-Marie
authors.initials: LM
authors.lastname: Johnson
authors.forename: Javier R
authors.initials: JR
authors.lastname: Kane
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Kasow
authors.forename: Yuri
authors.initials: Y
authors.lastname: Quintana
authors.forename: April
authors.initials: A
authors.lastname: Coan
authors.forename: Ying
authors.initials: Y
authors.lastname: Yuan
authors.forename: Raymond
authors.initials: R
authors.lastname: Barfield
authors.forename: Christopher
authors.initials: C
authors.lastname: Church
authors.forename: Micah
authors.initials: M
authors.lastname: Hester
authors.forename: Justin N
authors.initials: JN
authors.lastname: Baker
mesh_terms: D003657:Decision Making / Q000941:ethics*; D006801:Humans; D007182:Income; D008020:Life Support Care; D008495:Medical Oncology / Q000941:ethics*; D010166:Palliative Care; D012935:Social Justice; D013727:Terminal Care / Q000941:ethics*