Physician Perceptions of Pediatric Palliative Care for Children with Cancer in Latin America

Abstract

Background: The World Health Organization (WHO) designates early integration of palliative care as an ethical responsibility in the management of children with serious illness. While structural barriers may influence provision of pediatric palliative care (PPC) for children with cancer in resource-limited settings, underlying physician perceptions also impede early integration of PPC within cancer care. Methods: The Assessing Doctor’s Attitudes on Palliative Treatment (ADAPT) survey was developed for physicians who care for children with cancer and initially distributed in Eurasia. In this study, the survey was modified for use in Latin America including translation into Spanish and adapted for cultural context. Descriptive statistics were used to summarize the data, along with univariate and multivariable analyses of factors impacting knowledge and comfort in PPC practice. Open-ended questions were analyzed qualitatively to supplement the quantitative data. Findings: A total of ­­­­874 physicians from 17 countries completed the survey. Most physicians (56%) had no formal PPC training and 35% had no access to PPC experts for consultation. On average, providers’ perspectives on PPC were aligned with WHO guidance (­­­83% alignment, range 24% - 100%). However, only 50% of respondents felt comfortable addressing physical symptoms, 34% felt comfortable addressing emotional symptoms, and 25% felt comfortable addressing grief and bereavement for the patient’s family. Provider specialty and previous palliative care training were significantly associated with WHO alignment and physician comfort in addressing patient needs. Ninety-six percent of survey participants desired further education and training in PPC. Interpretation: Despite perspectives aligning with WHO guidance, this study identified opportunities for improving physician training in symptom management and emotional support for children with cancer and their families. These findings will inform the development of targeted interventions to enhance PPC education and improve the quality of care for children with cancer in Latin America. Funding Information: American Lebanese Syrian Associated Charities. Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: The Office of Human Subjects Research Protections and Institutional Review Board at St. Jude Children’s Research Hospital (Memphis, TN, USA) approved this study as exempt research. Additional local approvals were obtained as needed.