Skip to main content
SpringerLink
Log in

Japanese physicians’ attitudes toward end-of-life discussion with pediatric patients with cancer

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

A multicenter questionnaire survey was conducted with 127 pediatricians specializing in the treatment of pediatric cancer.

Results

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).

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. U.S (2004) Cancer statistics working group. United States Cancer statistics: 2004 incidence and mortality. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention and National Cancer Institute, Atlanta

    Google Scholar 

  2. Ministry of Health, Labor and Welfare. Statistics and Information Department. Vital Statistics. Tokyo; 2013: http://www.mhlw.go.jp/toukei/saikin/hw/jinkou/geppo/nengai12/dl/h7.pdf (2013). (In Japanese)

  3. Baile WF, Lenzi R, Parker PA, Buckman R, Cohen L (2002) Oncologists’ attitudes toward and practices in giving bad news: an exploratory study. J Clin Oncol 20:2189–2196

    Article  Google Scholar 

  4. Otani H, Morita T, Esaki T, Ariyama H, Tsukasa K, Oshima A, Shiraisi K (2011) Burden on oncologists when communicating the discontinuation of anticancer treatment. Jpn J Clin Oncol 41:999–1006

    Article  Google Scholar 

  5. Beale EA, Baile WF, Aaron J (2005) Silence is not golden: communicating with children dying from cancer. J Clin Oncol 23:3629–3631

    Article  Google Scholar 

  6. Parsons SK, Saiki-Craighill S, Mayer DK, Sullivan AM, Jeruss S, Terrin N, Tighiouart H, Nakagawa K, Iwata Y, Hara J, Grier HE, Block S (2007) Telling children and adolescents about their cancer diagnosis: cross-cultural comparisons between pediatric oncologists in the US and Japan. Psychooncology 16:60–68

    Article  Google Scholar 

  7. Bell CJ, Skiles J, Pradhan K, Champion VL (2010) End-of-life experiences in adolescents dying with cancer. Support Care Cancer 18:827–835

    Article  Google Scholar 

  8. Young B, Dixon-Woods M, Windridge KC, Heney D (2003) Managing communication with young people who have a potentially life threatening chronic illness: qualitative study of patients and parents. BMJ 326:305

    Article  Google Scholar 

  9. Scott JT, Harmsen M, Prictor MJ, Sowden AJ and Watt I (2003) Interventions for improving communication with children and adolescents about their cancer. Cochrane Database Syst Rev:CD002969

  10. Kreicbergs U, Valdimarsdóttir U, Onelöv E, Henter JI, Steineck G (2004) Talking about death with children who have severe malignant disease. N Engl J 351:1175–1186

    Article  CAS  Google Scholar 

  11. British Medical Association. (2001) Consent, rights, and choices in health care for children and young people. London: BMJ Books

  12. DoH (2002) Core principles for the involvement of children and young people. Listening, Hearing, and Responding. London

  13. Clarke SA, Davies H, Jenney M, Glaser A, Eiser C (2005) Parental communication and children’s behaviour following diagnosis of childhood leukaemia. Psychooncology 14:274–281

    Article  Google Scholar 

  14. Durall A, Zurakowski D, Wolfe J (2012) Barriers to conducting advance care discussions for children with life-threatening conditions. Pediatrics 129:e975–e982

    Article  Google Scholar 

  15. Kassam A, Skiadaresis J, Habib S, Alexander S, Wolfe J (2013) Moving toward quality palliative cancer care: parent and clinician perspectives on gaps between what matters and what is accessible. J Clin Oncol 31:910–915

    Article  Google Scholar 

  16. Yotani N, Kizawa Y, Shintaku H (2017) Differences between pediatricians and internists in advance care planning for adolescents with cancer. J Pediatr 182:356–362

    Article  Google Scholar 

  17. Sahler OJ, Frager G, Levetown M, Cohn FG, Lipson MA (2000) Medical education about end-of-life care in the pediatric setting: principles, challenges, and opportunities. Pediatrics 105:575–584

    Article  CAS  Google Scholar 

  18. Kenyon B (2001) Current research in children’s conceptions of death: a critical review. Omega J Death Dying 43:63–91

    Article  Google Scholar 

  19. Yoshida S, Shimizu K, Kobayashi M, Inoguchi H, Oshima Y, Dotani C, Nakahara R, Takahashi T, Kato M (2014) Barriers of healthcare providers against end-of-life discussions with pediatric cancer patients. Jpn J Clin Oncol 44:729–735

    Article  Google Scholar 

  20. Mori M, Shimizu C, Ogawa A, Okusaka T, Yoshida S, Morita T (2015) A national survey to systematically identify factors associated with oncologists’ attitudes toward end-of-life discussions: what determines timing of end-of-life discussions? Oncologist 20:1304–1311

    Article  Google Scholar 

  21. Granek L, Krzyzanowska MK, Tozer R, Mazzotta P (2013) Oncologists’ strategies and barriers to effective communication about the end of life. J Oncol Pract 9:e129–e135

    Article  Google Scholar 

  22. Davies B, Sehring SA, Partridge JC, Cooper BA, Hughes A, Philp JC, Amidi-Nouri A, Kramer RF (2008) Barriers to palliative care for children: perceptions of pediatric health care providers. Pediatrics 121:282–288

    Article  Google Scholar 

  23. Yoshida S, Hirai K, Morita T, Shiozaki M, Miyashita M, Sato K, Tsuneto S, Shima Y (2011) Experience with prognostic disclosure of families of Japanese patients with cancer. J Pain Symptom Manag 41:594–603

    Article  Google Scholar 

  24. Peppercorn JM, Smith TJ, Helft PR, Debono DJ, Berry SR, Wollins DS, Hayes DM, Von Roenn JH, Schnipper LE (2011) American society of clinical oncology statement: toward individualized care for patients with advanced cancer. J Clin Oncol 29:755–760

    Article  Google Scholar 

  25. Lotz JD, Jox RJ, Borasio GD, Fuhrer M (2013) Pediatric advance care planning: a systematic review. Pediatrics 131:e873–e880

    Article  Google Scholar 

  26. Mack JW, Joffe S (2014) Communicating about prognosis: ethical responsibilities of pediatricians and parents. Pediatrics 133(Suppl 1):S24–S30

    Article  Google Scholar 

  27. Balaban RB (2000) A physician’s guide to talking about end-of-life care. J Gen Intern Med 15:195–200

    Article  CAS  Google Scholar 

Download references

Funding

This study was supported by JSPS KAKENHI Grant Number 26780408.

Author information

Authors and Affiliations

  1. Graduate School of Education, Tohoku University, 27-1 Kawauchi, Aoba-ku, Sendai city, Miyagi, Japan

    Saran Yoshida

  2. Department of Pediatric Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan

    Chitose Ogawa

  3. Department of Psycho-oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan

    Ken Shimizu, Mariko Kobayashi, Hironobu Inoguchi & Rika Nakahara

  4. Division of Psycho-oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, Japan

    Yoshio Oshima

  5. Department of Pediatrics, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan

    Chikako Dotani

  6. Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan

    Masashi Kato

Authors
  1. Saran Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chitose Ogawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ken Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mariko Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hironobu Inoguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoshio Oshima
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chikako Dotani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rika Nakahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masashi Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Saran Yoshida.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoshida, S., Ogawa, C., Shimizu, K. et al. Japanese physicians’ attitudes toward end-of-life discussion with pediatric patients with cancer. Support Care Cancer 26, 3861–3871 (2018). https://doi.org/10.1007/s00520-018-4254-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-018-4254-6

Keywords

Search

Navigation