The oncologist should be the primary decision maker in some pediatric cancer situations, say researchers at Baylor College of Medicine (BCM) in Houston in an article appearing today in the Journal of Clinical Oncology.
"The conventional wisdom is that the patient (or parents) should always make the decision because that is their right and duty. We believe that is too simplistic; parents expect and need help from the clinician with difficult decisions," said Dr. Simon Whitney, assistant professor of family and community medicine at BCM.
Whitney, also an associate faculty member of the Center for Medical Ethics and Health Policy at BCM, says the most important thing for clinicians to understand is that there must be a constant dialogue between patients and clinicians. Patients look to clinicians for authority in decision making yet clinicians should know how to read, listen and explain the information so that parents thoroughly understand the options when they have to make a treatment decision.
Treatment options are complex and decisions must sometimes be made at a moment's notice. When there is one clear best way to treat the patient the physician should inform the parent and child of the one treatment option as if it is the only one, including any risks associated with the treatment.
"And in a sense, there is really no decision for the doctor or the parent if there is one best treatment for the child," said Whitney. "The decision has essentially already been made."
There are different reasons why the clinician, the child or the parent should take the lead role in the decision making and depends on each child's circumstances.