Supportive Care in Cancer

, Volume 26, Issue 11, pp 3861–3871 | Cite as

Japanese physicians’ attitudes toward end-of-life discussion with pediatric patients with cancer

  • Saran Yoshida
  • Chitose Ogawa
  • Ken Shimizu
  • Mariko Kobayashi
  • Hironobu Inoguchi
  • Yoshio Oshima
  • Chikako Dotani
  • Rika Nakahara
  • Masashi Kato
Original Article



We explored pediatricians’ practices and attitudes concerning end-of-life discussions (EOLds) with pediatric patients with cancer, and identified the determinants of pediatricians’ positive attitude toward having EOLds with pediatric patients.


A multicenter questionnaire survey was conducted with 127 pediatricians specializing in the treatment of pediatric cancer.


Forty-two percent of participants reported that EOLds should be held with the young group of children (6–9 years old), 68% with the middle group (10–15 years old), and 93% with the old group (16–18 years old). Meanwhile, 6, 20, and 35% of participants answered that they “always” or “usually” discussed the incurability of the disease with the young, middle, and old groups, respectively; for the patient’s imminent death, the rates were 2, 11, and 24%. Pediatricians’ attitude that they “should have” EOLds with the young group was predicted by more clinical experience (odds ratio [OR] 1.077; p = 0.007), more confidence in addressing children’s anxiety after EOLd (OR 1.756; p = 0.050), weaker belief in the demand for EOLd (OR 0.456; p = 0.015), weaker belief in the necessity of the EOLd for children to enjoy their time until death (OR, 0.506; p = 0.021), and weaker belief in the importance of maintaining a good relationship with the parents (OR 0.381; p = 0.025).


While pediatricians nearly reached consensus on EOLds for the old group, EOLds with the young group remain a controversial subject. While pediatricians who supported EOLds believed in their effectiveness or necessity, those who were against EOLds tended to consider the benefits of not engaging in them.


End-of-life discussion Communication Attitude Palliative care 



This study was supported by JSPS KAKENHI Grant Number 26780408.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    U.S (2004) Cancer statistics working group. United States Cancer statistics: 2004 incidence and mortality. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention and National Cancer Institute, AtlantaGoogle Scholar
  2. 2.
    Ministry of Health, Labor and Welfare. Statistics and Information Department. Vital Statistics. Tokyo; 2013: (2013). (In Japanese)
  3. 3.
    Baile WF, Lenzi R, Parker PA, Buckman R, Cohen L (2002) Oncologists’ attitudes toward and practices in giving bad news: an exploratory study. J Clin Oncol 20:2189–2196CrossRefGoogle Scholar
  4. 4.
    Otani H, Morita T, Esaki T, Ariyama H, Tsukasa K, Oshima A, Shiraisi K (2011) Burden on oncologists when communicating the discontinuation of anticancer treatment. Jpn J Clin Oncol 41:999–1006CrossRefGoogle Scholar
  5. 5.
    Beale EA, Baile WF, Aaron J (2005) Silence is not golden: communicating with children dying from cancer. J Clin Oncol 23:3629–3631CrossRefGoogle Scholar
  6. 6.
    Parsons SK, Saiki-Craighill S, Mayer DK, Sullivan AM, Jeruss S, Terrin N, Tighiouart H, Nakagawa K, Iwata Y, Hara J, Grier HE, Block S (2007) Telling children and adolescents about their cancer diagnosis: cross-cultural comparisons between pediatric oncologists in the US and Japan. Psychooncology 16:60–68CrossRefGoogle Scholar
  7. 7.
    Bell CJ, Skiles J, Pradhan K, Champion VL (2010) End-of-life experiences in adolescents dying with cancer. Support Care Cancer 18:827–835CrossRefGoogle Scholar
  8. 8.
    Young B, Dixon-Woods M, Windridge KC, Heney D (2003) Managing communication with young people who have a potentially life threatening chronic illness: qualitative study of patients and parents. BMJ 326:305CrossRefGoogle Scholar
  9. 9.
    Scott JT, Harmsen M, Prictor MJ, Sowden AJ and Watt I (2003) Interventions for improving communication with children and adolescents about their cancer. Cochrane Database Syst Rev:CD002969Google Scholar
  10. 10.
    Kreicbergs U, Valdimarsdóttir U, Onelöv E, Henter JI, Steineck G (2004) Talking about death with children who have severe malignant disease. N Engl J 351:1175–1186CrossRefGoogle Scholar
  11. 11.
    British Medical Association. (2001) Consent, rights, and choices in health care for children and young people. London: BMJ BooksGoogle Scholar
  12. 12.
    DoH (2002) Core principles for the involvement of children and young people. Listening, Hearing, and Responding. LondonGoogle Scholar
  13. 13.
    Clarke SA, Davies H, Jenney M, Glaser A, Eiser C (2005) Parental communication and children’s behaviour following diagnosis of childhood leukaemia. Psychooncology 14:274–281CrossRefGoogle Scholar
  14. 14.
    Durall A, Zurakowski D, Wolfe J (2012) Barriers to conducting advance care discussions for children with life-threatening conditions. Pediatrics 129:e975–e982CrossRefGoogle Scholar
  15. 15.
    Kassam A, Skiadaresis J, Habib S, Alexander S, Wolfe J (2013) Moving toward quality palliative cancer care: parent and clinician perspectives on gaps between what matters and what is accessible. J Clin Oncol 31:910–915CrossRefGoogle Scholar
  16. 16.
    Yotani N, Kizawa Y, Shintaku H (2017) Differences between pediatricians and internists in advance care planning for adolescents with cancer. J Pediatr 182:356–362CrossRefGoogle Scholar
  17. 17.
    Sahler OJ, Frager G, Levetown M, Cohn FG, Lipson MA (2000) Medical education about end-of-life care in the pediatric setting: principles, challenges, and opportunities. Pediatrics 105:575–584CrossRefGoogle Scholar
  18. 18.
    Kenyon B (2001) Current research in children’s conceptions of death: a critical review. Omega J Death Dying 43:63–91CrossRefGoogle Scholar
  19. 19.
    Yoshida S, Shimizu K, Kobayashi M, Inoguchi H, Oshima Y, Dotani C, Nakahara R, Takahashi T, Kato M (2014) Barriers of healthcare providers against end-of-life discussions with pediatric cancer patients. Jpn J Clin Oncol 44:729–735CrossRefGoogle Scholar
  20. 20.
    Mori M, Shimizu C, Ogawa A, Okusaka T, Yoshida S, Morita T (2015) A national survey to systematically identify factors associated with oncologists’ attitudes toward end-of-life discussions: what determines timing of end-of-life discussions? Oncologist 20:1304–1311CrossRefGoogle Scholar
  21. 21.
    Granek L, Krzyzanowska MK, Tozer R, Mazzotta P (2013) Oncologists’ strategies and barriers to effective communication about the end of life. J Oncol Pract 9:e129–e135CrossRefGoogle Scholar
  22. 22.
    Davies B, Sehring SA, Partridge JC, Cooper BA, Hughes A, Philp JC, Amidi-Nouri A, Kramer RF (2008) Barriers to palliative care for children: perceptions of pediatric health care providers. Pediatrics 121:282–288CrossRefGoogle Scholar
  23. 23.
    Yoshida S, Hirai K, Morita T, Shiozaki M, Miyashita M, Sato K, Tsuneto S, Shima Y (2011) Experience with prognostic disclosure of families of Japanese patients with cancer. J Pain Symptom Manag 41:594–603CrossRefGoogle Scholar
  24. 24.
    Peppercorn JM, Smith TJ, Helft PR, Debono DJ, Berry SR, Wollins DS, Hayes DM, Von Roenn JH, Schnipper LE (2011) American society of clinical oncology statement: toward individualized care for patients with advanced cancer. J Clin Oncol 29:755–760CrossRefGoogle Scholar
  25. 25.
    Lotz JD, Jox RJ, Borasio GD, Fuhrer M (2013) Pediatric advance care planning: a systematic review. Pediatrics 131:e873–e880CrossRefGoogle Scholar
  26. 26.
    Mack JW, Joffe S (2014) Communicating about prognosis: ethical responsibilities of pediatricians and parents. Pediatrics 133(Suppl 1):S24–S30CrossRefGoogle Scholar
  27. 27.
    Balaban RB (2000) A physician’s guide to talking about end-of-life care. J Gen Intern Med 15:195–200CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Graduate School of EducationTohoku UniversitySendai cityJapan
  2. 2.Department of Pediatric OncologyNational Cancer Center HospitalTokyoJapan
  3. 3.Department of Psycho-oncologyNational Cancer Center HospitalTokyoJapan
  4. 4.Division of Psycho-oncologyThe Cancer Institute Hospital of the Japanese Foundation for Cancer ResearchTokyoJapan
  5. 5.Department of PediatricsThe University of Tokyo HospitalTokyoJapan
  6. 6.Center for Cancer Control and Information ServicesNational Cancer CenterTokyoJapan

Personalised recommendations