Abstract
BackgroundThe world literature shows that empirical research regarding the process of decision-making when cancer in adolescents is no longer curable has been conducted in High-income, English speaking countries. The objective of the current study was to explore in-depth and to explain the decision-making process from the perspective of Mexican oncologists, parents, and affected adolescents and to identify the ethical principles that guide such decision-making.MethodsPurposive, qualitative design based on individual, fact-to-face, semi-structured, in-depth interviews. The participants were thirteen paediatric oncologists, 13 parents or primary carers, and six adolescents with incurable cancer. The participants were recruited from the paediatric oncology services of three national tertiary-care medical centres in Mexico City.ResultsThe oncologists stated that they broach the subject of palliative management when they have determined that curative treatment has failed. Respect for autonomy was understood as the assent of the parent/adolescent to what the oncologist determined to be in the best interest of the adolescent. The oncologists thought that the adolescent should be involved in the decision-making. They also identified the ability to count on a palliative care clinic or service as an urgent need. For the parents, it was essential that the oncologist be truly interested in their adolescent child. The parents did not consider it necessary to inform the child about impending death. The adolescents stated that the honesty of their oncologists was important; however, several of them opted for a passive role in the decision-making process.ConclusionThe findings of this study evidence that to achieve good medical practice in low-middle income countries, like Mexico, it is urgent to begin effective implementation of palliative care, together with appropriate training and continuing education in the ethics of clinical practice.
Highlights
The world literature shows that empirical research regarding the process of decision-making when cancer in adolescents is no longer curable has been conducted in High-income, English speaking countries
The 13 oncologists interviewed had a median of seven years of work experience and held primary responsibility for providing medical care for the adolescents included in this study
Thirteen parents participated in the study; the age range of their adolescents with cancer was from 13 to 18 years old
Summary
The world literature shows that empirical research regarding the process of decision-making when cancer in adolescents is no longer curable has been conducted in High-income, English speaking countries. A 2014 systematic review [1] of studies, published between 1988 and 2012, shows that the majority of empirical research about the decision-making process when cancer treatment in children and adolescents is no longer curative is based primarily upon interviews with bereaved parents, and to a lesser extent, on interviews with attending oncologists, and on reviews of medical. The results from these studies cannot be extrapolated to Mexico because of the characteristics of its culture, especially those relating to feelings, values, beliefs, and patterns of communication in the decision-making process during medical treatment. In medicine, illness and death tend to be viewed through the lens of biomedical explanation and Mexican culture plays a peripheral role
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