Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Palliative Care
Published in: BMC Palliative Care 1/2022

Open Access 01-12-2022 | Care | Research

Physician decision-making process about withholding/withdrawing life-sustaining treatments in paediatric patients: a systematic review of qualitative evidence

Authors: Yajing Zhong, Alice Cavolo, Veerle Labarque, Chris Gastmans

Published in: BMC Palliative Care | Issue 1/2022

Login to get access

Abstract

Background

With paediatric patients, deciding whether to withhold/withdraw life-sustaining treatments (LST) at the end of life is difficult and ethically sensitive. Little is understood about how and why physicians decide on withholding/withdrawing LST at the end of life in paediatric patients. In this study, we aimed to synthesise results from the literature on physicians’ perceptions about decision-making when dealing with withholding/withdrawing life-sustaining treatments in paediatric patients.

Methods

We conducted a systematic review of empirical qualitative studies. Five electronic databases (Pubmed, Cinahl®, Embase®, Scopus®, Web of Science™) were exhaustively searched in order to identify articles published in English from inception through March 17, 2021. Analysis and synthesis were guided by the Qualitative Analysis Guide of Leuven.

Results

Thirty publications met our criteria and were included for analysis. Overall, we found that physicians agreed to involve parents, and to a lesser extent, children in the decision-making process about withholding/withdrawing LST. Our analysis to identify conceptual schemes revealed that physicians divided their decision-making into three stages: (1) early preparation via advance care planning, (2) information giving and receiving, and (3) arriving at the final decision. Physicians considered advocating for the best interests of the child and of the parents as their major focus. We also identified moderating factors of decision-making, such as facilitators and barriers, specifically those related to physicians and parents that influenced physicians’ decision-making.

Conclusions

By focusing on stakeholders, structure of the decision-making process, ethical values, and influencing factors, our analysis showed that physicians generally agreed to share the decision-making with parents and the child, especially for adolescents. Further research is required to better understand how to minimise the negative impact of barriers on the decision-making process (e.g., difficult involvement of children, lack of paediatric palliative care expertise, conflict with parents).
Appendix
Available only for authorised users
Literature
1.
2.
Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Jiang Kwete X, et al. Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the lancet commission report. Lancet. 2018;391(10128):1391–454.PubMedCrossRef
3.
Field MJ, Behrman RE: Institute of Medicine (US) Committee on Palliative and End-of-Life Care for Children and Their Families. When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. National Academies Press (US) Copyright 2003 by the National Academy of Sciences. 2003.
4.
5.
World Health Organization. Integrating palliative care and symptom relief into Paediatrics: a WHO guide for health-care planners, implementers and managers. Geneva: World Health Organization; 2018.
6.
Cass H, Barclay S, Gerada C, Lumsden DE, Sritharan K. Complexity and challenge in paediatrics: a roadmap for supporting clinical staff and families. Arch Dis Child. 2020;105(2):109–14.PubMed
7.
Fraser LK, Miller M, Hain R, Norman P, Aldridge J, McKinney PA, et al. Rising national prevalence of life-limiting conditions in children in England. Pediatrics. 2012;129(4):e923–9.PubMedCrossRef
8.
9.
Prentice T, Janvier A, Gillam L, Davis PG. Moral distress within neonatal and paediatric intensive care units: a systematic review. Arch Dis Child. 2016;101(8):701–8.PubMedCrossRef
10.
McDougall R, Notini L, Phillips J. Conflicts between parents and health professionals about a Child's medical treatment: using clinical ethics records to find gaps in the bioethics literature. J Bioeth Inq. 2015;12(3):429–36.PubMedCrossRef
11.
Feudtner C, Nathanson PG. Pediatric palliative care and pediatric medical ethics: opportunities and challenges. Pediatrics. 2014;133(Suppl 1):S1–7.PubMedCrossRef
12.
Masri C, Farrell CA, Lacroix J, Rocker G, Shemie SD. Decision making and end-of-life care in critically ill children. J Palliat Care. 2000;16(Suppl):S45–52.PubMedCrossRef
13.
14.
Audigé M, Gillam L, Stark Z. Treatment limitation and advance planning: hospital-wide audit of paediatric death. J Paediatr Child Health. 2020;56(6):893–9.PubMedCrossRef
15.
Trowbridge A, Bamat T, Griffis H, McConathey E, Feudtner C, Walter JK. Pediatric resident experience caring for children at the end of life in a Children's hospital. Acad Pediatr. 2020;20(1):81–8.PubMedCrossRef
16.
Plymire CJ, Miller EG, Frizzola M. Retrospective review of limitations of Care for Inpatients at a free-standing, Tertiary Care Children’s Hospital. Children (Basel). 2018;5(12):164.
17.
Massie AM, Ebelhar J, Allen KE, DeGroote NP, Wasilewski-Masker K, Brock KE. Defining and timing of palliative opportunities in children with central nervous system tumors. Neurooncol Pract. 2021;8(4):451–9.PubMedPubMedCentral
18.
Launes C, Cambra FJ, Jordán I, Palomeque A. Withholding or withdrawing life-sustaining treatments: an 8-yr retrospective review in a Spanish pediatric intensive care unit. Pediatr Crit Care Med. 2011;12(6):e383–5.PubMedCrossRef
19.
Liu H, Su D, Guo X, Dai Y, Dong X, Zhu Q, et al. Withdrawal of treatment in a pediatric intensive care unit at a Children's Hospital in China: a 10-year retrospective study. BMC Med Ethics. 2020;21(1):71.PubMedPubMedCentralCrossRef
20.
Weise KL, Okun AL, Carter BS, Christian CW. Guidance on forgoing life-sustaining medical treatment. Pediatrics. 2017;140(3):e20171905.PubMedCrossRef
21.
22.
Carnevale FA, Giannini A, Bonaldi A, Bravi E, Cecchi C, Pettenazzo A, et al. Life-sustaining treatment decisions in pediatric intensive care: an Italian survey on ethical concerns. Ital J Pediatr. 2021;47(1):153.PubMedPubMedCentralCrossRef
23.
Burns JP, Rushton CH. End-of-life care in the pediatric intensive care unit: research review and recommendations. Crit Care Clin. 2004;20(3):467–85.PubMedCrossRef
24.
Stenmarker M, Hallberg U, Palmérus K, Márky I. Being a messenger of life-threatening conditions: experiences of pediatric oncologists. Pediatr Blood Cancer. 2010;55(3):478–84.PubMedCrossRef
25.
Day E, Jones L, Langner R, Bluebond-Langner M. Current understanding of decision-making in adolescents with cancer: a narrative systematic review. Palliat Med. 2016;30(10):920–34.PubMedPubMedCentralCrossRef
26.
27.
Moore P, Kerridge I, Gillis J, Jacobe S, Isaacs D. Withdrawal and limitation of life-sustaining treatments in a paediatric intensive care unit and review of the literature. J Paediatr Child Health. 2008;44(7–8):404–8.PubMedCrossRef
28.
Sampson M, McGowan J, Cogo E, Grimshaw J, Moher D, Lefebvre C. An evidence-based practice guideline for the peer review of electronic search strategies. J Clin Epidemiol. 2009;62(9):944–52.PubMedCrossRef
29.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. Bmj. 2009;339:b2700.PubMedPubMedCentralCrossRef
30.
31.
32.
Dierckx de Casterlé B, De Vliegher K, Gastmans C, Mertens E. Complex qualitative data analysis: lessons learned from the experiences with the qualitative analysis guide of Leuven. Qual Health Res. 2021;31(6):1083–93.PubMedCrossRef
33.
Dierckx de Casterlé B, Gastmans C, Bryon E, Denier Y. QUAGOL: a guide for qualitative data analysis. Int J Nurs Stud. 2012;49(3):360–71.PubMedCrossRef
34.
Fauriel I, Moutel G, Moutard ML, Montuclard L, Duchange N, Callies I, et al. Decisions concerning potentially life-sustaining treatments in paediatric nephrology: a multicentre study in French-speaking countries. Nephrol Dial Transplant. 2004;19(5):1252–7.PubMedCrossRef
35.
De Graves S, Aranda S. When a child cannot be cured - reflections of health professionals. Eur J Cancer Care (Engl). 2005;14(2):132–40.CrossRef
36.
Fauriel I, Moutel G, Duchange N, Montuclard L, Moutard ML, Cochat P, et al. Decision making concerning life-sustaining treatment in paediatric nephrology: professionals’ experiences and values. Nephrol Dial Transplant. 2005;20(12):2746–50.PubMedCrossRef
37.
Carnevale FA, Benedetti M, Bonaldi A, Bravi E, Trabucco G, Biban P. Understanding the private worlds of physicians, nurses, and parents: a study of life-sustaining treatment decisions in Italian paediatric critical care. J Child Health Care. 2011;15(4):334–49.PubMedCrossRef
38.
Carnevale FA, Farrell C, Cremer R, Canoui P, Séguret S, Gaudreault J, et al. Struggling to do what is right for the child: pediatric life-support decisions among physicians and nurses in France and Quebec. J Child Health Care. 2012;16(2):109–23.PubMedCrossRef
39.
Meyer EC, Lamiani G, Foer MR, Truog RD. “What would you do if this were your child?”: practitioners’ responses during enacted conversations in the United States. Pediatr Crit Care Med. 2012;13(6):e372–6.PubMedCrossRef
40.
Michelson KN, Patel R, Haber-Barker N, Emanuel L, Frader J. End-of-life care decisions in the PICU: roles professionals play. Pediatr Crit Care Med. 2013;14(1):e34–44.PubMedPubMedCentralCrossRef
41.
Pye K. Exploring moral distress in pediatric oncology; a sample of registered practitioners. Issues Compr Pediatr Nurs. 2013;36(4):248–61.PubMedCrossRef
42.
Bartholdson C, Lützén K, Blomgren K, Pergert P. Experiences of ethical issues when caring for children with cancer. Cancer Nurs. 2015;38(2):125–32.PubMedCrossRef
43.
Boss RD, Hutton N, Griffin PL, Wieczorek BH, Donohue PK. Novel legislation for pediatric advance directives: surveys and focus groups capture parent and clinician perspectives. Palliat Med. 2015;29(4):346–53.PubMedCrossRef
44.
de Vos MA, Bos AP, Plötz FB, van Heerde M, de Graaff BM, Tates K, et al. Talking with parents about end-of-life decisions for their children. Pediatrics. 2015;135(2):e465–76.PubMedCrossRef
45.
Forbat L, Teuten B, Barclay S. Conflict escalation in paediatric services: findings from a qualitative study. Arch Dis Child. 2015;100(8):769–73.PubMedCrossRef
46.
Lotz JD, Jox RJ, Borasio GD, Führer M. Pediatric advance care planning from the perspective of health care professionals: a qualitative interview study. Palliat Med. 2015;29(3):212–22.PubMedPubMedCentralCrossRef
47.
Mitchell S, Dale J. Advance care planning in palliative care: a qualitative investigation into the perspective of Paediatric intensive care unit staff. Palliat Med. 2015;29(4):371–9.PubMedCrossRef
48.
Bartholdson C, Lützén K, Blomgren K, Pergert P. Clarifying perspectives: ethics case reflection sessions in childhood cancer care. Nurs Ethics. 2016;23(4):421–31.PubMedCrossRef
49.
Bateman LB, Tofil NM, White ML, Dure LS, Clair JM, Needham BL. Physician communication in pediatric end-of-life care: a simulation study. Am J Hosp Palliat Care. 2016;33(10):935–41.PubMedCrossRef
50.
Lotz JD, Jox RJ, Meurer C, Borasio GD, Führer M. Medical indication regarding life-sustaining treatment for children: focus groups with clinicians. Palliat Med. 2016;30(10):960–70.PubMedPubMedCentralCrossRef
51.
Zaal-Schuller IH, Willems DL, Ewals F, van Goudoever JB, de Vos MA. How parents and physicians experience end-of-life decision-making for children with profound intellectual and multiple disabilities. Res Dev Disabil. 2016;59:283–93.PubMedCrossRef
52.
Badarau DO, Ruhe K, Kühne T, De Clercq E, Colita A, Elger BS, et al. Decision making in pediatric oncology: views of parents and physicians in two European countries. AJOB Empir Bioeth. 2017;8(1):21–31.PubMedCrossRef
53.
Birchley G, Gooberman-Hill R, Deans Z, Fraser J, Huxtable R. ‘Best interests’ in paediatric intensive care: an empirical ethics study. Arch Dis Child. 2017;102(10):930–5.PubMedCrossRef
54.
Cicero-Oneto CE, Valdez-Martinez E, Bedolla M. Decision-making on therapeutic futility in Mexican adolescents with cancer: a qualitative study. BMC Med Ethics. 2017;18(1):74.PubMedPubMedCentralCrossRef
55.
Odeniyi F, Nathanson PG, Schall TE, Walter JK. Communication challenges of oncologists and intensivists caring for pediatric oncology patients: a qualitative study. J Pain Symptom Manag. 2017;54(6):909–15.CrossRef
56.
Richards CA, Starks H, O'Connor MR, Bourget E, Hays RM, Doorenbos AZ. Physicians perceptions of shared decision-making in neonatal and pediatric critical care. Am J Hosp Palliat Care. 2018;35(4):669–76.PubMedCrossRef
57.
Needle JS, Peden-McAlpine C, Liaschenko J. Physicians’ perspectives on adolescent and Young adult advance care planning the fallacy of informed decision making. J Clin Ethics. 2019;30(2):131–42.PubMed
58.
Sasazuki M, Sakai Y, Kira R, Toda N, Ichimiya Y, Akamine S, et al. Decision-making dilemmas of paediatricians: a qualitative study in Japan. BMJ Open. 2019;9(8):e026579.PubMedPubMedCentralCrossRef
59.
Ekberg S, Danby S, Herbert A, Bradford NK, Yates P. Affording opportunities to discuss deterioration in paediatric palliative care consultations: a conversation analytic study. BMJ Support Palliat Care. 2020;10(2):e13.PubMedCrossRef
60.
Jongaramraung J, Chanprasit C, Mesukko J, Niyomkar S, Reungrongrat S. End-of-life decisions for children in a Thai pediatric intensive care unit: a qualitative descriptive study. Pac Rim Int J Nurs Res. 2020;24(3):321–34.
61.
Orkin J, Beaune L, Moore C, Weiser N, Arje D, Rapoport A, et al. Toward an understanding of advance care planning in children with medical complexity. Pediatrics. 2020;145(3):e20192241.PubMedCrossRef
62.
Fay M, Guadarrama J, Colmenares-Roa T, Moreno-Licona I, Cruz-Martin AG, Peláez-Ballestas I. The relationship between proxy agency and the medical decisions concerning pediatric patients in palliative care: a qualitative study. BMC Palliat Care. 2021;20(1):27.PubMedPubMedCentralCrossRef
63.
Verberne LM, Fahner JC, Sondaal SFV, Schouten-van Meeteren AYN, de Kruiff CC, van Delden JJM, et al. Anticipating the future of the child and family in pediatric palliative care: a qualitative study into the perspectives of parents and healthcare professionals. Eur J Pediatr. 2021;180(3):949–57.PubMedCrossRef
64.
65.
Katz AL, Webb SA. Informed consent in decision-making in pediatric practice. Pediatrics. 2016;138(2):e20161485.PubMedCrossRef
66.
Talati ED, Lang CW, Ross LF. Reactions of pediatricians to refusals of medical treatment for minors. J Adolesc Health. 2010;47(2):126–32.PubMedCrossRef
67.
Alahmad G, AlSaqabi M, Alkamli H, Aleidan M. Ethical challenges in consent procedures involving pediatric cancer patients in Saudi Arabia: an exploratory survey. Dev World Bioeth. 2021;00:1–12.
68.
Rosenberg AR, Wolfe J, Wiener L, Lyon M, Feudtner C. Ethics, emotions, and the skills of talking about progressing disease with terminally ill adolescents: a review. JAMA Pediatr. 2016;170(12):1216–23.PubMedPubMedCentralCrossRef
69.
Adams P, Fras I. Beginning child psychiatry. New York: Brunner/Mazel; 1988.
70.
Kestenbaum C, Williams D. Handbook of clinical assessment of children and adolescents. New York: University Press; 1988.
71.
Harrison C, Kenny NP, Sidarous M, Rowell M. Bioethics for clinicians: 9. Involving children in medical decisions. CMAJ. 1997;156(6):825–8.PubMedPubMedCentral
72.
Pousset G, Bilsen J, Cohen J, Chambaere K, Deliens L, Mortier F. Medical end-of-life decisions in children in Flanders, Belgium: a population-based postmortem survey. Arch Pediatr Adolesc Med. 2010;164(6):547–53.PubMedCrossRef
73.
Lindly OJ, Geldhof GJ, Acock AC, Sakuma KK, Zuckerman KE, Thorburn S. Family-centered care measurement and associations with unmet health care need among US children. Acad Pediatr. 2017;17(6):656–64.PubMedCrossRef
74.
Tenniglo LJA, Loeffen EAH, Kremer LCM, Font-Gonzalez A, Mulder RL, Postma A, et al. Patients’ and parents’ views regarding supportive care in childhood cancer. Support Care Cancer. 2017;25(10):3151–60.PubMedPubMedCentralCrossRef
75.
Dreesens D, Veul L, Westermann J, Wijnands N, Kremer L, van der Weijden T, et al. The clinical practice guideline palliative care for children and other strategies to enhance shared decision-making in pediatric palliative care; pediatricians’ critical reflections. BMC Pediatr. 2019;19(1):467.PubMedPubMedCentralCrossRef
76.
Sisk BA, Canavera K, Sharma A, Baker JN, Johnson LM. Ethical issues in the care of adolescent and young adult oncology patients. Pediatr Blood Cancer. 2019;66(5):e27608.PubMedCrossRef
77.
Randolph AG, Zollo MB, Egger MJ, Guyatt GH, Nelson RM, Stidham GL. Variability in physician opinion on limiting pediatric life support. Pediatrics. 1999;103(4):e46.PubMedCrossRef
78.
Bahus MK, Føerde R. Parents as decision-makers--do the attitudes of Norwegian doctors conform to law? Eur J Health Law. 2011;18(5):531–47.PubMedCrossRef
79.
Aljethaily A, Al-Mutairi T, Al-Harbi K, Al-Khonezan S, Aljethaily A, Al-Homaidhi HS. Pediatricians’ perceptions toward do not resuscitate: a survey in Saudi Arabia and literature review. Adv Med Educ Pract. 2020;11:1–8.PubMedPubMedCentralCrossRef
80.
Forbes T, Goeman E, Stark Z, Hynson J, Forrester M. Discussing withdrawing and withholding of life-sustaining medical treatment in a tertiary paediatric hospital: a survey of clinician attitudes and practices. J Paediatr Child Health. 2008;44(7–8):392–8.PubMedCrossRef
81.
Yotani N, Kizawa Y, Shintaku H. Differences between pediatricians and internists in advance care planning for adolescents with Cancer. J Pediatr. 2017;182:356–62.PubMedCrossRef
82.
Yotani N, Kizawa Y, Shintaku H. Advance care planning for adolescent patients with life-threatening neurological conditions: a survey of Japanese paediatric neurologists. BMJ Paediatr Open. 2017;1(1):e000102.PubMedPubMedCentralCrossRef
83.
Yoo SH, Choi W, Kim Y, Kim MS, Park HY, Keam B, et al. Difficulties doctors experience during life-sustaining treatment discussion after enactment of the life-sustaining treatment decisions act: a cross-sectional study. Cancer Res Treat. 2021;53(2):584–92.PubMedCrossRef
84.
Klein SM. Moral distress in pediatric palliative care: a case study. J Pain Symptom Manag. 2009;38(1):157–60.CrossRef
85.
Stolper M, Metselaar S, Molewijki B, Widdershoven G. Moral case deliberation in an academic hospital in the Netherlands. Tensions between theory and practice. J Int Bioethique. 2012;23(3–4):53–66 191–192.PubMedCrossRef
86.
Johnson LM, Church CL, Metzger M, Baker JN. Ethics consultation in pediatrics: long-term experience from a pediatric oncology center. Am J Bioeth. 2015;15(5):3–17.PubMedPubMedCentralCrossRef
87.
Archambault-Grenier MA, Roy-Gagnon MH, Gauvin F, Doucet H, Humbert N, Stojanovic S, et al. Survey highlights the need for specific interventions to reduce frequent conflicts between healthcare professionals providing paediatric end-of-life care. Acta Paediatr. 2018;107(2):262–9.PubMedCrossRef
88.
Inguaggiato G, Metselaar S, Molewijk B, Widdershoven G. How moral case deliberation supports good clinical decision making. AMA J Ethics. 2019;21(10):E913–9.PubMedCrossRef
89.
Weiner C, Pergert P, Molewijk B, Castor A, Bartholdson C. Perceptions of important outcomes of moral case deliberations: a qualitative study among healthcare professionals in childhood cancer care. BMC Med Ethics. 2021;22(1):27.PubMedPubMedCentralCrossRef
90.
Chong LA, Khalid F. Paediatric palliative care in Malaysia: survey of knowledge base and barriers to referral. Prog Palliat Care. 2014;22:195–200.CrossRef
91.
Henderson A, Young J, Herbert A, Bradford N, Pedersen LA. Preparing pediatric healthcare professionals for end-of-life care discussions: an exploratory study. J Palliat Med. 2017;20(6):662–6.PubMedCrossRef
92.
93.
Basu S, Swil K. Paediatric advance care planning: physician experience and education in initiating difficult discussions. J Paediatr Child Health. 2018;54(5):510–4.PubMedCrossRef
94.
Peng NH, Lee CH, Lee MC, Huang LC, Chang YC, DeSwarte-Wallace J. Effectiveness of pediatric palliative care education on pediatric clinicians. West J Nurs Res. 2017;39(12):1624–38.PubMedCrossRef
95.
Zuniga-Villanueva G, Ramirez-GarciaLuna JL, Weingarten K. Factors associated with knowledge and comfort providing palliative care: a survey of pediatricians in Mexico. J Palliat Care. 2019;34(2):132–8.PubMedCrossRef
96.
Moya-Dionisio V. Knowledge of primary care pediatricians about pediatric palliative care in the principality of Asturias, Spain. Bol Med Hosp Infant Mex. 2020;77(4):195–201.PubMed
97.
Whitla L, Devins M, Molloy EJ, Twomey M, O'Reilly M, Balfe J. Children’s palliative care; the identified learning needs of Paediatricians. Ir Med J. 2020;113(6):95.PubMed
98.
Contro NA, Larson J, Scofield S, Sourkes B, Cohen HJ. Hospital staff and family perspectives regarding quality of pediatric palliative care. Pediatrics. 2004;114(5):1248–52.PubMedCrossRef
99.
Davies B, Sehring SA, Partridge JC, Cooper BA, Hughes A, Philp JC, et al. Barriers to palliative care for children: perceptions of pediatric health care providers. Pediatrics. 2008;121(2):282–8.PubMedCrossRef
Metadata
Title
Physician decision-making process about withholding/withdrawing life-sustaining treatments in paediatric patients: a systematic review of qualitative evidence
Authors
Yajing Zhong
Alice Cavolo
Veerle Labarque
Chris Gastmans
Publication date
01-12-2022
Publisher
BioMed Central
Keywords
Care
Pediatrics
Published in
BMC Palliative Care / Issue 1/2022
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-022-01003-5

Other articles of this Issue 1/2022

BMC Palliative Care 1/2022 Go to the issue

Research

Evaluation of an advance care planning training program for practice professionals in Japan incorporating shared decision making skills training: a prospective study of a curricular intervention

Research

Development and palliative care staff reactions to a sleep regulation educational intervention

Research

Chief complaints of patients with cancer who visit the emergency department over their oncologist’s outpatient clinic in South Korea

Research

Factors related to implementation of an interprofessional communication concept in thoracic oncology: a mixed-methods study

Research

Development of the palliative care referral system: proposal of a tool for the referral of cancer patients to specialized palliative care

Research

Assessing professional identity formation (PIF) amongst medical students in Oncology and Palliative Medicine postings: a SEBA guided scoping review