Poor Parent-to-Provider Agreement in Pediatric Cancer
Poor concordance regarding prognosis and goals of care; variation seen by cancer type.
For pediatric patients with advanced cancer, parent-provider concordance is poor regarding prognosis and goals of care, according to a study published online in the Journal of Clinical Oncology.
Abby R. Rosenberg, M.D., from Seattle Children's Hospital, and colleagues describe parent-provider concordance regarding prognosis and goals of care for 104 pediatric patients with recurrent or refractory cancer. Parents and providers were surveyed on perceived prognosis and goals of care on enrollment, and data were available for 77 dyads (74 percent of those enrolled). Survival status was retrospectively abstracted from medical records.
The researchers found that there was poor parent-provider agreement regarding prognosis and goals of care. Parents were significantly more likely to report that cure was possible (P < 0.001). For both parents and providers, the frequency of perceived likelihood of cure and goal of cure varied by cancer type (P < 0.001 to 0.004). Among parents and providers of patients with hematological malignancies, relatively optimistic responses were more common, although no differences in survival were noted.
"Parent-provider concordance regarding prognosis and goals in advanced pediatric cancer is generally poor," the authors write. "Understanding these differences may inform parent-provider communication and decision making."