A pilot study of people with advanced cancer indicates that parental status is an important factor in treatment decision-making, with the majority stating that being a parent motivates them to pursue life-extending treatments, according to research presented this week at ASCO’s 2014 Quality Care Symposium by Devon Check, a Ph.D. student at the University of North Carolina at Chapel Hill.
Findings from a pilot study of 42 parents with advanced cancer indicate that parental status is an important factor in treatment decision-making. When asked how having children influences their treatment decisions, the majority of parents (64 percent) responded that being a parent motivates them to pursue life-extending treatments, largely out of a desire to have more time with their children. A smaller proportion of parents (15 percent) identified preserving parental functioning as a treatment priority, and 12 percent mentioned the importance of receiving treatment close to their families, versus traveling for a second opinion, or pursuing treatment that may require long hospital stays. Parenting concerns identified in this study will inform further research in this understudied patient population.
“Numerous psychosocial factors influence patients’ decisions about cancer treatment. It’s important for patients with dependent children to discuss their treatment priorities with their oncologist, who may not know, for example, how important it is for a patient with children to preserve their functioning at home,” said lead author Devon Check, a Ph.D. student at the University of North Carolina at Chapel Hill. “We hope that our study can help oncologists engage patients with children in shared decision making and promote alignment of the treatment plan with the patients’ priorities, including family responsibilities.”
Prior studies suggested that patients with advanced cancer who are parents prefer aggressive treatments for their illness more often than patients who are not parents. The present study, which focused solely on patients with dependent children, is the first to directly ask parents if and how having children affects their treatment preferences, beyond serving as a motivator for aggressive treatment, including preferences for palliative care and hospice. It is also the first to include qualitative methods, which helped elucidate more nuanced factors influencing decision-making.
Researchers interviewed 42 patients with metastatic cancer who have children younger than 18 years. Parents had an average age of 44, and the average age of their children was 12. When queried about preferences for palliative care and hospice, 52 percent of parents indicated an interest in using hospice services. Of these parents, many recognized hospice as a supportive resource for their family. Others were specifically interested in institutional versus home hospice care, due to a desire to protect their children from the dying experience. Twenty-four percent of parents reported an interest in receiving palliative care concurrent with their cancer treatment, although several parents seemed to conflate palliative care with end-of-life care.
Although this study included patients with a range of physical functioning and a variety of cancer types, the findings may not generalize to other patient groups. But with these initial data in hand, the researchers are already planning a larger study to explore the associations between parental status, parenting concerns and medical decision-making about treatment for advanced cancer.