The timing and circumstances of the implementation of pediatric palliative care in Hungarian pediatric oncology

The timing and circumstances of the implementation of pediatric palliative care in Hungarian pediatric oncology

Nyiro J; Zorgo S; Eniko F; Hegedus K; Hauser P

European Journal of Pediatrics

2018

child death; parent; family; terminal care; priority journal; psychologist; doctor patient relation; constructive feedback; childhood cancer; cancer palliative therapy; cohort analysis; oncologist; structured interview; human; article; female; male; adult; exploratory research; time to treatment; ambivalence; data analysis software; Hungarian (citizen); Hungary

Despite the continuous improvement of pediatric palliative care, medical professionals still face various barriers regarding its implementation; our aim was to investigate this question in Hungarian pediatric oncology practice. Structured interviews were carried out in person with physicians from the Hungarian Pediatric Oncology Group (n = 22). Codes were generated inductively with the aid of Atlas.ti 6.0 software. Most physicians placed the palliative care discussion at the end of curative treatment (n = 21) and preferred to conduct it in a team setting (n = 18), mainly in the presence of a psychologist. Preparing parents for the child's death can occur during the palliative care discussion (n = 3), in the child's final days/h (n = 6), gradually (n = 10), or never (n = 3). There are words consciously utilized and avoided during this discussion, with the word "death" proving to be the most ambivalent (utilized n = 5, avoided n = 6). Conclusions: There is no widely accepted unified practice among pediatric oncologists concerning the implementation of palliative care in Hungary. Despite the international recommendation, the common practice of timing is still at the end of curative treatment. Physicians rely on multidisciplinary teamwork, where the psychologist's role is the most prominent in this discussion.What is Known:* There is an international consensus that palliative care should commence at the diagnosis of a pediatric malignant disease regardless of illness outcome.* Barriers to the early implementation of palliative care in pediatric oncology involve resource-based and attitudinal factors.What is New:* In Hungary, where pediatric oncologists are sole decision-makers, early implementation of palliative care is rare.* There is a strong preference among physicians for working within a team, while also asserting that presence of team members may decrease the level of intimacy.

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