Barriers to Palliative Care Integration for Children With Cancer Across Asia Pacific.
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Cuviello Andrea, Salek Marta, Handayani Sri Andini, Blair Sally, Chandra Anjali, Job Godwin, Ehrlich Bella S, Chandra Lynna, Drake Ross, Gunasekera Sanjeeva, Kakazu Mariko, Kang Sung Han, Leão Lurdes Maria do R, Mahajan Amita, Miranda Michelle Cristine, Moe Thida, Mynak Mimi Lhamu, Nguyen Hoa Thi Kim, Rasheed Eman, Sipai Sani, Souvalansy Bounpalisone, Sripornsawan Pornpun, Tan Teresa Shu Zhen, Teh Kok Hoi, Yotani Nobuyuki, Lee Ai Chong, Bagai Poonam, Bee Ong Gek, Bravo Shella, Buang Siti Nur Hanim, Bui Huyen Thi Thanh, Choden Tashi, Giri Bishnu Rath, Graetz Dylan E, Gupta Haresh, Poh Heng Chong, Kaye Erica C, Khaiman Chusana, Khaing Aye Aye, Kim Min Sun, Kurniati Nia, Laughton Stephen, Mlis Ratha, Ngoc Lan Bui, Quintero Ximena Garcia, Rios Diana, Dos Santos Milena Maria Lay, Sapkota Sudhir, Sari Teny Tjitra, Sharma Krishna Sagar, Sorrosa Rojim, Tabjaroen Sommaphun, Wahyuni Rina, Watanabe Kazuyo, Yandana Su, Yi Yi Wynn, Zaki Maziya Abbas, Devidas Meenakshi, Baker Justin N, McNeil Michael J, Agulnik Asya, Lam Catherine G
Аннотация
METHODS: The Assessing Doctors' Attitudes on Palliative Treatment survey was revised for cultural context, translated into six languages, and distributed electronically to physicians who care for children with cancer. Descriptive statistics were used to summarize data. Secondary analyses used the Pearson chi-square test or Fisher exact test to examine associations between prior PC training and physician subspecialty with reported barriers. The McNemar test was applied to evaluate differences between actual versus ideal timing of PC consultations. Analysis of variance was conducted to compare mean values for perceived barriers across country income levels.
RESULTS: Six hundred twenty-one physicians from 18 countries participated, with an overall response rate of 27% (621/2,305) and a median country response rate of 30% (range, 11%-85%). Most respondents (n = 366; 59%) believed PC should be consulted at diagnosis, but only 18% (n = 117) stated that this occurred in their clinical setting (P < .001). The most highly ranked barriers to PC provision included limited physician knowledge (n = 511; 82%), lack of national health policy/advocacy (n = 494; 79%), lack of PC-trained clinicians (n = 492; 79%), lack of home-based services (n = 487; 78%), and physician discomfort in discussing PC (n = 483; 78%). Physicians practicing in lower-middle-income countries rated these barriers more significantly.
CONCLUSION: Physicians report a discrepancy between ideal and actual timing of PC integration and identify several barriers to PC provision. Study findings will inform capacity building, education, and advocacy initiatives to improve the timing and quality of PC delivery in the region.