How the Role of Being a Parent Influences Patient Treatment Decisions

Photo Credit: Devin Hubbard

Devon Check, PhD student

A new study has found that parents with dependent children are more likely to pursue life-extending treatments in order to have more time with their children.

The study, which will be presented at the 2014 ASCO Quality Care Symposium October 17-18, enrolled 42 patients with metastatic cancer who have children younger than 18 years old. The study 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.

“Previous studies have established that among people with advanced cancer, parents versus non-parents are more likely to prefer aggressive treatment versus treatment focused on comfort and alleviation of symptoms,” lead author Devon Checka, a PhD student at the University of Carolina, in Chapel Hill, said during a press briefing. “We wanted to learn more about why that is and also whether having children influences parents’ treatment preferences in other ways beyond serving as a motivator for life-extending treatment.”

Parents enrolled on the study were an average age of 44, and the average age of their children was 12.

When asked how having children influences their treatment decisions, 64% responded that being a parent motivates them to pursue life-extending treatments, largely out of a desire to have more time with their children.

Interestingly, 24% of participants said the fact that they had children had no influence on their decisions to pursue life-extending treatments.

“As far as cancer treatment, surprisingly, about a quarter of parents did not perceive that having children influenced their treatment preferences,” Check said. “And this was largely because they felt they had other reasons, other people to live for. For example, [one participant said] ‘if I didn’t have kids and got cancer, it’s not like I’d say alright let’s go home.’”

Parents who said their children had an influence on their treatment decisions also mentioned that they would be willing to take however many treatments were necessary in order to gain them the most amount of time with their children, regardless of side effects.

“Several parents were pretty explicit about this quality versus quantity of life trade-off,” Check said.

However, 24% of the participants identified preserving parental functioning, such as driving their children around or preparing dinner, as a treatment priority.

The study also found that 12% of parents cited the importance of receiving treatment in close proximity to their families, versus traveling for a second opinion, pursuing treatment that may require long hospital stays, or participating in clinical trials.

When queried about preferences for palliative care and hospice, 52% of parents indicated an interest in using hospice services at some points. 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.

In addition, 59% of parents said they were interested in palliative care or felt they were already receiving it. Also, 14% 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.

“Thus, many parents’ responses to this question were not the sort of clear-cut yes-or-no answers that we had anticipated,” Check said.

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,” Check said. “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.”

“This abstract emphasizes the need to individualize our approach to patients with unique circumstances, such as these patients with young children who may need more support with some of these difficult decisions,” Gregory A. Masters, MD, the director of Medical Oncology Fellowship program at Christiana Care Health System said during the press breifing. “So I think it is critical to understand our population and their needs and certainly in the future it would be great to see some more studies comparing these needs to other different populations and trying to incorporate palliative care, which we know is so important for patients with advanced stages of cancer.”

Reference:

Check DK. How does having children influence parents’ preferences for advanced cancer treatment? Results from a mixed methods study. Presented at ASCO's Quality Care Symposium. October 17-18, 2014.