Physician Perceptions Toward Palliative Care Integration in Childhood Cancer Care in Asia Pacific

Palliative care (PC) integration in pediatric oncology improves outcomes, yet access to PC in the Asia Pacific (AP) region remains limited. This study aimed to understand physician perceptions of PC integration in childhood cancer care across AP.

The validated Assessing Doctors' Attitudes on Palliative Treatment survey was modified for use in AP, translated into six languages, and adapted for cultural relevance. The survey was distributed electronically between February 2022 and February 2024 to physicians caring for children with cancer in 18 AP countries. The primary outcome was alignment with WHO PC guidance, calculated as a mean percentage per physician. Secondary analyses explored associations between demographic variables and WHO alignment scores using regression analyses. Open-ended responses were analyzed qualitatively.

A total of 621 physicians from 18 countries participated (median country response rate 30%; range, 11%-85% per country). Most (70%; n = 432) had >10 years of clinical experience and no prior PC training (65%; n = 401). Although 57% (n = 352) had access to pediatric PC experts, only 50% (n = 308), 36% (n = 221), 27% (n = 166), and 34% (n = 209) expressed comfort addressing patient/family physical, emotional, spiritual, and grief/bereavement needs, respectively. Additionally, 40% (n = 248) reported feeling burdened addressing end-of-life suffering. The mean alignment with WHO guidance was 76% (range, 48%-92%). Almost all (>90%; n = 570) desired further PC training.

Study findings demonstrate that most physicians in AP expressed discomfort with providing core components of PC to patients with cancer and their families. This study signals the urgent need for focused expansion of PC services and training and identifies regional opportunities to improve PC education, research, and advocacy efforts.