title: Differences between Pediatricians and Internists in Advance Care Planning for Adolescents with Cancer.
abstract: To evaluate differences between pediatricians and internists in the practice of and barriers to advance care planning (ACP) for adolescent patients with cancer.
  
  
  
  A self-reported questionnaire was administered to assess the practice of ACP, advance directives, and barriers to ACP for adolescent patients with cancer. All 3392 Japanese board-certified hematologists were surveyed, and 600 hematologists (227 pediatricians, 373 internists) who take care of adolescent patients with cancer with decision-making capacity were analyzed.
  
  
  
  If a patient's prognosis for survival was <3 months, pediatricians were significantly less likely to discuss ACP with their patients than internists, including discussions regarding the patient's medical condition (59% vs 70%), the patient's understanding of his/her medical condition (55% vs 66%), do not attempt resuscitation orders (17% vs 24%), and ventilator treatment if the patient's condition worsened (19% vs 25%). More than 75% of hematologists (both pediatricians and internists) discussed all ACP topics with patients' families. Similarly, with regard to advance directives, pediatricians were less likely than internists to discuss cardiopulmonary resuscitation (24% vs 47%) and the use of ventilators (31% vs 51%), vasopressors (24% vs 42%), and antibiotics (21% vs 31%) with their patients. Both pediatricians and internists discussed these issues more often with patients' families than with patients, especially cardiopulmonary resuscitation (98%) as well as the use of ventilators (98%) and vasopressors (91%).
  
  
  
  Pediatricians were less likely than internists to discuss ACP and advance directives with patients, and both pediatricians and internists tended to discuss ACP and advance directives more often with patients' families.
authors.affiliation: Kobe University Graduate School of Medicine, Kobe, Japan; Osaka City University Graduate School of Medicine, Osaka, Japan. Electronic address: yotani-n@ncchd.go.jp.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yotani
authors.affiliation: Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kizawa
authors.affiliation: Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Haruo
authors.initials: H
authors.lastname: Shintaku
mesh_terms: D000293:Adolescent; D000328:Adult; D032722:Advance Care Planning / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making; D005260:Female; D019538:Health Care Surveys; D020445:Hospitalists; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008511:Medicine; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D000072143:Pediatricians; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D011795:Surveys and Questionnaires
keywords: DNAR; advance directive; barrier; decision-making capacity; hematologist