Decision-making on therapeutic futility in Mexican adolescents with cancer: a qualitative study

BMC Medical Ethics

Research Article

Carlo Egysto Cicero-Oneto¹  Edith Valdez-Martinez²  Miguel Bedolla³ 

[1] Haemato-Oncology Department Hospital Infantil de Mexico “Federico Gómez”, National Health Institute of the Secretariat of Health, Mexico City, Mexico;Health Research Council of the Mexican Institute of Social Security, Centro Medico Nacional Siglo XXI, Av. Cuauhtemoc #330. Col. Doctores, C.P. 06720 Ciudad de Mexico, Mexico City, Mexico;Policy Studies Centre of the College of Public Policy, University of Texas in San Antonio, San Antonio Texas, USA;

关键词: Cancer;    Palliative care;    Adolescents;    Parents;    Physicians;    End-of-life;    Decision-making;    Mexico;   

DOI  :  10.1186/s12910-017-0231-8

 received in 2017-04-21, accepted in 2017-11-27,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe world literature shows that empirical research regarding the process of decision-making when cancer in adolescents is no longer curable has been conducted in High-income, English speaking countries. The objective of the current study was to explore in-depth and to explain the decision-making process from the perspective of Mexican oncologists, parents, and affected adolescents and to identify the ethical principles that guide such decision-making.MethodsPurposive, qualitative design based on individual, fact-to-face, semi-structured, in-depth interviews. The participants were thirteen paediatric oncologists, 13 parents or primary carers, and six adolescents with incurable cancer. The participants were recruited from the paediatric oncology services of three national tertiary-care medical centres in Mexico City.ResultsThe oncologists stated that they broach the subject of palliative management when they have determined that curative treatment has failed. Respect for autonomy was understood as the assent of the parent/adolescent to what the oncologist determined to be in the best interest of the adolescent. The oncologists thought that the adolescent should be involved in the decision-making. They also identified the ability to count on a palliative care clinic or service as an urgent need. For the parents, it was essential that the oncologist be truly interested in their adolescent child. The parents did not consider it necessary to inform the child about impending death. The adolescents stated that the honesty of their oncologists was important; however, several of them opted for a passive role in the decision-making process.ConclusionThe findings of this study evidence that to achieve good medical practice in low-middle income countries, like Mexico, it is urgent to begin effective implementation of palliative care, together with appropriate training and continuing education in the ethics of clinical practice.

【 授权许可】

CC BY   
© The Author(s). 2017