Browsing by Author "Maradiege, E"

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    Exploring treatment decision-making at diagnosis for children with advanced cancer in low- and middle-income countries
    (Springer Science and Business Media Deutschland GmbH, 2024) Salek, M; Porter, AS; Maradiege, E; Dolendo, MCJ; Figueredo, D; Geriga, F; Gunasekera, S; Kizyma, R; Nguyen, HTK; Nzamu, I; Raza, MR; Rustamova, K; Sari, NM; Rodriguez-Galindo, C; Graetz, D; Bhakta, N; Kaye, EC; Wise, PH; Hunleth, JM; Friedrich, P; Force, L; Baker, JN
    Purpose: Global childhood cancer survival outcomes correlate with regional contextual factors, yet upfront treatment decision-making for children with advanced or poor prognosis cancer in low- and middle-income countries (LMICs) is not well understood. This study aimed to (1) characterize the landscape of contextual factors that shape physician decision-making at diagnosis for these children in LMICs and (2) describe physician rationales for if/when to offer treatment with non-curative intent, including how they define “poor prognosis” during treatment decision-making. Methods: An international panel of pediatric oncologists practicing in LMICs participated in two focus groups structured for the collaborative generation of factors influencing treatment decision-making, including consideration of non-curative treatment pathways at diagnosis. Thematic analysis of qualitative data was conducted, followed by member checking. Results: Eleven pediatric oncologists participated, representing all global regions defined by the World Health Organization. Participants identified a broad range of factors influencing decision-making across multiple levels, including the individual, hospital, health system, community, and country levels. All participants agreed that treatment with non-curative intent could be offered at diagnosis in certain contexts, and diverse definitions for poor prognosis were described. Conclusions: Upfront treatment decision-making for children with advanced or poor prognosis cancer in LMICs is variable and challenging. Difficulties with decision-making in LMICs may be amplified by inconsistent definitions of poor prognosis and underrepresentation of the factors that influence treatment decision-making within existing decision-making frameworks or childhood cancer treatment guidelines. Future research should explore decision-making approaches, preferences, and challenges in depth from the perspectives of pediatric cancer patients, families, and multidisciplinary clinicians. © The Author(s) 2024.