Physician Perceptions Toward Palliative Care Integration in Childhood Cancer Care in Asia Pacific
Marta Salek, Andrea Cuviello, Sri Andini Handayani, Sally Blair, Anjali Chandra, Godwin Job, Bella S. Ehrlich, Lee Ai Chong, Poonam Bagai, Ong Gek Bee, Shella Bravo, Siti Nur Hanim Buang, Huyen Thi Thanh Bui, Lynna Chandra, Tashi Choden, Ross Drake, Bishnu Rath Giri, Dylan E. Graetz, Sanjeeva Gunasekera, Haresh Gupta, Chong Poh Heng, Mariko Kakazu, Sung Han Kang, Erica C. Kaye, Chusana Khaiman, Aye Aye Khaing, Min Sun Kim, Nia Kurniati, Stephen Laughton, Lurdes Maria do R. Leão, Amita Mahajan, Michelle Cristine Miranda, Ratha Mlis, Thida Moe, Mimi Lhamu Mynak, Lan Bui Ngoc, Hoa Thi Kim Nguyen, Ximena Garcia Quintero, Eman Rasheed, Diana Rios, Milena Maria Lay Dos Santos, Sudhir Sapkota, Teny Tjitra Sari, Krishna Sagar Sharma, Sani Sipai, Rojim Sorrosa, Bounpalisone Souvalansy, Pornpun Sripornsawan, Sommaphun Tabjaroen, Teresa Shu Zhen Tan, Kok Hoi Teh, Rina Wahyuni, Kazuyo Watanabe, Su Yadana, Wynn Yi Yi, Nobuyuki Yotani, Maziya Abbas Zaki, Meenakshi Devidas, Justin N. Baker, Michael J. McNeil, Asya Agulnik, Catherine G. LamPURPOSE
Palliative care (PC) integration in pediatric oncology improves outcomes, yet access to PC in the Asia Pacific (AP) region remains limited. This study aimed to understand physician perceptions of PC integration in childhood cancer care across AP.
METHODS
The validated Assessing Doctors' Attitudes on Palliative Treatment survey was modified for use in AP, translated into six languages, and adapted for cultural relevance. The survey was distributed electronically between February 2022 and February 2024 to physicians caring for children with cancer in 18 AP countries. The primary outcome was alignment with WHO PC guidance, calculated as a mean percentage per physician. Secondary analyses explored associations between demographic variables and WHO alignment scores using regression analyses. Open-ended responses were analyzed qualitatively.
RESULTS
A total of 621 physicians from 18 countries participated (median country response rate 30%; range, 11%-85% per country). Most (70%; n = 432) had >10 years of clinical experience and no prior PC training (65%; n = 401). Although 57% (n = 352) had access to pediatric PC experts, only 50% (n = 308), 36% (n = 221), 27% (n = 166), and 34% (n = 209) expressed comfort addressing patient/family physical, emotional, spiritual, and grief/bereavement needs, respectively. Additionally, 40% (n = 248) reported feeling burdened addressing end-of-life suffering. The mean alignment with WHO guidance was 76% (range, 48%-92%). Almost all (>90%; n = 570) desired further PC training.
CONCLUSION
Study findings demonstrate that most physicians in AP expressed discomfort with providing core components of PC to patients with cancer and their families. This study signals the urgent need for focused expansion of PC services and training and identifies regional opportunities to improve PC education, research, and advocacy efforts.