Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee.
Division of Quality of Life and Palliative Care Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee.
JAMA Netw Open. 2022 Mar 1;5(3):e221245. doi: 10.1001/jamanetworkopen.2022.1245.
The World Health Organization (WHO) designates early integration of palliative care as an ethical responsibility in the treatment of children with serious illness. Although structural barriers may influence provision of pediatric palliative care (PPC) for children with cancer in resource-limited settings, underlying physician perceptions may also impede early integration of PPC in cancer care.
To investigate perceptions among physicians in Latin America about the integration of palliative care for children with cancer.
DESIGN, SETTING, AND PARTICIPANTS: This survey study used the Assessing Doctors' Attitudes on Palliative Treatment (ADAPT) survey, which was developed for physicians who care for children with cancer and was initially distributed in Eurasia. The survey was modified for use in Latin America, including translation into Spanish and adaptation for cultural context. The survey was distributed between August 21, 2020, and January 31, 2021, to physicians treating children with cancer in 17 Latin American countries. Each country had a specific survey distribution method based on guidance of local experts.
The ADAPT survey evaluated physicians' understanding of palliative care principles, comfort in addressing patient and family suffering, and identification of barriers to PPC integration for children with cancer. Univariate and multivariable linear regression analyses were used to assess factors associated with physicians' knowledge about and comfort with PPC practice and whether independent physician variables were associated with survey response alignment with WHO guidance on PPC. Open-ended questions were analyzed qualitatively to supplement the quantitative data.
A total of 874 physicians from 17 countries participated, with an overall response rate of 39.9% (874 of 2193) and a median country response rate of 51.4% (range, 23.7%-100%). Most respondents were aged 35 years or older (577 [66.0%]), and 594 (68.0%) identified as female. Most physicians (486 [55.6%]) had no formal PPC training, and 303 (34.7%) had no access to PPC experts for consultation. Physician perspectives on PPC were generally aligned with WHO guidance (mean [SD] alignment, 83.0% [14.1%]; range among respondents, 24.0%-100%). However, only 438 respondents (50.1%) felt comfortable addressing physical symptoms of patients receiving PPC, 295 (33.8%) felt comfortable addressing emotional symptoms, and 216 (24.7%) felt comfortable addressing grief and bereavement needs of the patient's family. A total of 829 participants (94.8%) desired further education and training in PPC.
Although physicians' perspectives aligned well with WHO guidance for PPC, this survey study identified opportunities for improving physician training in symptom management and emotional support for children with cancer and their families. These findings may inform the development of targeted interventions to improve the quality of PPC for children with cancer in Latin America.
世界卫生组织（WHO）将姑息治疗的早期综合纳入治疗重病儿童的伦理责任。尽管结构障碍可能会影响资源有限环境下为癌症儿童提供儿科姑息治疗（PPC），但潜在的医生观念也可能阻碍癌症护理中 PPC 的早期综合。
调查拉丁美洲医生对癌症儿童姑息治疗综合的看法。
设计、设置和参与者：本调查研究使用了评估医生对姑息治疗态度的问卷调查（ADAPT），该问卷是为治疗癌症儿童的医生开发的，最初在欧亚大陆分发。该调查针对拉丁美洲进行了修改，包括翻译成西班牙语和适应文化背景。该调查于 2020 年 8 月 21 日至 2021 年 1 月 31 日分发给 17 个拉丁美洲国家治疗癌症儿童的医生。每个国家都根据当地专家的指导采用了特定的调查分配方法。
ADAPT 调查评估了医生对姑息治疗原则的理解、处理患者和家庭痛苦的舒适度，以及确定癌症儿童 PPC 整合的障碍。使用单变量和多变量线性回归分析评估了与医生对 PPC 实践的知识和舒适度相关的因素，以及独立医生变量是否与 WHO 关于 PPC 的指导意见一致。对开放式问题进行了定性分析，以补充定量数据。
共有来自 17 个国家的 874 名医生参与，总体回复率为 39.9%（874 名中有 2193 名），中位数国家回复率为 51.4%（范围为 23.7%-100%）。大多数受访者年龄在 35 岁或以上（577[66.0%]），594 名（68.0%）为女性。大多数医生（486[55.6%]）没有接受过正式的 PPC 培训，303 名（34.7%）无法咨询 PPC 专家。医生对 PPC 的看法总体上与 WHO 指导意见一致（平均[SD]一致性，83.0%[14.1%]；受访者范围，24.0%-100%）。然而，只有 438 名受访者（50.1%）表示愿意处理接受 PPC 的患者的身体症状，295 名（33.8%）表示愿意处理情绪症状，216 名（24.7%）表示愿意处理患者家属的悲伤和丧亲需要。共有 829 名参与者（94.8%）希望在 PPC 方面接受进一步的教育和培训。
尽管医生的观点与 WHO 关于 PPC 的指导意见一致，但这项调查研究确定了在症状管理和癌症儿童及其家庭的情感支持方面改善医生培训的机会。这些发现可能为改善拉丁美洲癌症儿童 PPC 的质量提供信息。
