Physicians' Perspectives and Attitudes Toward Palliative Care for Cancer Children in Mainland China.

Abstract

Integrating pediatric palliative care (PPC) into the routine care of children with cancer improves outcomes for children and their families. Understanding physician perceptions of PPC in mainland China is crucial for enhancing PPC services. This study adapted and translated the Assessing Doctors' Attitudes on Palliative Treatment survey for use in mainland China. Univariate and multivariable linear regression analyses were used. Open-ended questions were analyzed qualitatively to supplement the quantitative data. A total of 368 physicians treating children with cancer from 25 provinces in China participated (98.4% response rate). Most were older than 35 years old and female. Only 108 (29.4%) participants had received palliative training, with 232 (63.0%) having access to palliative consultation. The most common misperceptions included the belief that early palliative care consultation increases parental burden and anxiety (51.3%) and that palliative care is synonymous with end-of-life care (55.7%). Previous access to palliative care education and consultation were two independent factors influencing physician alignment to the WHO guidance. Physician comfort in addressing the patient's palliative care needs was low, and many (157, 42.7%) felt burdened by their inability to control children's suffering at the end of life. Although most institutions have joined the China PPC subgroup, gaps in knowledge, misconceptions, lack of access to PPC professionals, and physician's discomfort remain significant challenges across mainland China. Addressing these issues through targeted education, capacity building and support systems are essential for improving care for children with cancer.