title: Concerns underlying treatment preferences of advanced cancer patients with children.
abstract: BACKGROUND
  Decision-making about advanced cancer treatment is complex and may be influenced by patients' family context, including the presence of children. We explored how parental values and concerns motivate patients' preferences about aggressiveness of advanced cancer treatment as well as preferences for palliative care and hospice services.
  
  
  METHODS
  We conducted semi-structured interviews with 42 patients with advanced cancer who had at least one child under 18 years. We created and applied thematic codes. Descriptive analyses were used to report the number of participants who mentioned each code.
  
  
  RESULTS
  The majority of participants (29/42) reported that having children influenced their preferences for advanced cancer care. For most parents, extending life to maximize the time they had left to parent their children was important in guiding treatment preferences. Others prioritized preserving their physical condition and parental functioning and remaining physically close to their children. Many parents discussed life extension and parental functioning preservation as competing priorities. Most of the sample expressed interest in palliative care services and hospice, but responses by several participants reflected concerns about dying at home and lack of clarity about the role of early palliative care.
  
  
  CONCLUSIONS
  Parents in our sample expressed that maximizing time with their children and preserving parental functioning were important concerns underlying their preferences for advanced cancer care. Future research should assess the palliative and end-of-life care needs and preferences of parents with advanced cancer, which may differ from those of non-parents. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Devon K
authors.initials: DK
authors.lastname: Check
authors.affiliation: Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA.|University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
authors.forename: Eliza M
authors.initials: EM
authors.lastname: Park
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.|University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Reeder-Hayes
authors.affiliation: School of Nursing, University of North Carolina, Chapel Hill, NC, USA.|University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Mayer
authors.affiliation: University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Deal
authors.affiliation: Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Yopp
authors.affiliation: Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA.|Division of Hematology and Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.|University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Rosenstein
authors.affiliation: Division of Geriatric Medicine and Palliative Care Program, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.|University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Hanson
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003657:Decision Making; D005260:Female; D017051:Hospice Care; D006738:Hospices; D006801:Humans; D007407:Interviews as Topic; D008017:Life Expectancy; D008297:Male; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D010166:Palliative Care; D010290:Parents / Q000523:psychology*; D057240:Patient Preference; D012720:Severity of Illness Index; D013727:Terminal Care
keywords: cancer; end-of-life care; oncology; quality of life; treatment preferences