JCO Global Oncology (Aug 2023)

Physician Perceptions of and Barriers to Pediatric Palliative Care for Children With Cancer in Brazil

  • Michael J. McNeil,
  • Alyssa Godfrey,
  • Patricia Loggetto,
  • André de Oliveira Junior,
  • Godwin Job,
  • Erica Boldrini,
  • Glaucia Regina Costa Murra,
  • Dileiny Antunes Geronutti Ayub,
  • Allan Francisco Oliveira de Lima,
  • Aline Esmeraldo Andrade de Almeida,
  • Julia Lopes Garcia,
  • Anna Beatriz Costa Neves do Amaral,
  • Iêda Cristina Cunha Ferreira e Fonseca,
  • Paola Friedrich,
  • Monika L. Metzger,
  • Meenakshi Devidas,
  • Asya Agulnik,
  • Justin N. Baker

DOI
https://doi.org/10.1200/GO.23.00057
Journal volume & issue
no. 9

Abstract

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PURPOSEEarly integration of pediatric palliative care (PPC) for children with cancer is critical to improving the quality of life of both the patient and family. Understanding physician perceptions of palliative care and perceived barriers to early integration is necessary to develop PPC in Brazil.METHODSThe Assessing Doctors' Attitudes on Palliative Treatment survey was modified for use in Brazil. The survey was open from January 2022 to June 2022 and distributed to physicians of all specialties from participating institutions who treat children with cancer. Statistical analysis was complemented by qualitative analysis of open-ended responses.RESULTSA total of 272 respondents participated. Most respondents reported access to PPC experts for consultation (77.2%) and 34.5% indicated previous palliative care training. Physician knowledge of PPC was generally aligned with WHO guidance (median alignment, 93.0%; range, 80.5%-98.2%). However, about half (53.3%) felt comfortable addressing physical needs of patients receiving PPC, 35.3% addressing emotional needs, 25.8% addressing spiritual needs, and 33.5% addressing grief and bereavement needs. Most respondents (65.4%) felt palliative care should be involved from diagnosis, but only 10.3% stated that this occurred in their setting. The most important barriers identified were physician discomfort (89.0%), limited physician knowledge (88.6%), and lack of home-based services (83.8%).CONCLUSIONDespite a strong understanding of the role of palliative care, physicians in Brazil reported low confidence delivering PPC to children with cancer. Additionally, physicians generally believed that PPC should be integrated earlier in the disease trajectory of children with cancer. This work will direct educational and capacity building initiatives to ensure greater access to high-quality PPC for children with cancer in Brazil to address patient and family suffering.