Graduate School of Education, Tohoku University, 27-1 Kawauchi, Aoba-ku, Sendai city, Miyagi, Japan.
Department of Pediatric Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan.
Support Care Cancer. 2018 Nov;26(11):3861-3871. doi: 10.1007/s00520-018-4254-6. Epub 2018 May 17.
We explored pediatricians' practices and attitudes concerning end-of-life discussions (EOLds) with pediatric patients with cancer, and identified the determinants of pediatricians' positive attitude toward having EOLds with pediatric patients.
A multicenter questionnaire survey was conducted with 127 pediatricians specializing in the treatment of pediatric cancer.
Forty-two percent of participants reported that EOLds should be held with the young group of children (6-9 years old), 68% with the middle group (10-15 years old), and 93% with the old group (16-18 years old). Meanwhile, 6, 20, and 35% of participants answered that they "always" or "usually" discussed the incurability of the disease with the young, middle, and old groups, respectively; for the patient's imminent death, the rates were 2, 11, and 24%. Pediatricians' attitude that they "should have" EOLds with the young group was predicted by more clinical experience (odds ratio [OR] 1.077; p = 0.007), more confidence in addressing children's anxiety after EOLd (OR 1.756; p = 0.050), weaker belief in the demand for EOLd (OR 0.456; p = 0.015), weaker belief in the necessity of the EOLd for children to enjoy their time until death (OR, 0.506; p = 0.021), and weaker belief in the importance of maintaining a good relationship with the parents (OR 0.381; p = 0.025).
While pediatricians nearly reached consensus on EOLds for the old group, EOLds with the young group remain a controversial subject. While pediatricians who supported EOLds believed in their effectiveness or necessity, those who were against EOLds tended to consider the benefits of not engaging in them.
我们探讨了儿科医生在与患有癌症的儿科患者进行临终讨论（EOLd）方面的实践和态度，并确定了儿科医生对与儿科患者进行 EOLd 的积极态度的决定因素。
对 127 名专门治疗儿科癌症的儿科医生进行了一项多中心问卷调查。
42%的参与者报告说，EOLd 应该与年幼组的儿童（6-9 岁）、68%的中等年龄组（10-15 岁）和 93%的老年组（16-18 岁）进行。同时，6%、20%和 35%的参与者回答说，他们“总是”或“通常”与年幼、中等和老年组讨论疾病的不可治愈性；对于患者即将死亡，这些比例分别为 2%、11%和 24%。儿科医生认为他们“应该”与年幼组进行 EOLd 的态度，这与更多的临床经验有关（优势比 [OR] 1.077；p=0.007），对 EOLd 后儿童焦虑的处理更有信心（OR 1.756；p=0.050），对 EOLd 需求的信念较弱（OR 0.456；p=0.015），对 EOLd 对儿童享受死亡前时间的必要性的信念较弱（OR，0.506；p=0.021），对维持与父母良好关系的重要性的信念较弱（OR 0.381；p=0.025）。
虽然儿科医生几乎就老年组的 EOLd 达成共识，但与年幼组的 EOLd 仍然是一个有争议的话题。虽然支持 EOLd 的儿科医生相信其有效性或必要性，但反对 EOLd 的儿科医生往往认为不进行 EOLd 的好处。
