Caring for children, focusing on children

Mitchell, Ian; Guichon, Juliet R.; Wong, Sam

doi:10.1093/pch/20.6.293

Cited by 4 publications

(4 citation statements)

References 1 publication

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“… 66 Physicians in all settings must be aware of the potential for patients to prefer T&CM over conventional therapy and of the local legal, ethical, and moral norms, particularly as these may be in evolution. 6 , 83 The rates of abandonment and delay of treatment due to T&CM in LIC/LMIC are likely higher than what is currently reported in the literature, as there may be a large number of patients with oncologic conditions who are being managed solely by traditional practitioners, who never present to an oncology treating team. 13 , 84 Unfortunately, few studies reported on this important issue.…”

Section: Discussionmentioning

confidence: 99%

Global Use of Traditional and Complementary Medicine in Childhood Cancer: A Systematic Review

Diorio

Lam

Ladas

et al. 2017

JGO

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PurposeTraditional and complementary medicine (T&CM) strategies are commonly used in pediatric oncology. Patterns may vary based on country income. We systematically reviewed published studies describing T&CM use among pediatric oncology patients in low-income countries (LIC/LMIC), middle-income countries (UMIC), and high-income countries (HIC). Objectives included describing estimated prevalence of use, reasons for use, perceived effectiveness, modalities used, rates of disclosure, and reporting of delayed or abandoned treatment.MethodsMEDLINE, EMBASE, Global Health, CINAHL, PsycINFO, Allied and Complementary Medicine Database, Cochrane Database of Systematic Reviews, and ProceedingsFirst were searched. Inclusion criteria were primary studies involving children younger than the age of 18 years, undergoing active treatment of cancer, and any T&CM use. Exclusion criteria included no pediatric oncology–specific outcomes and studies involving only children off active treatment. Data were extracted by two reviewers using a systematic data extraction form determined a priori.ResultsSixty-five studies published between 1977 and 2015 were included, representing 61 unique data sets and 7,219 children from 34 countries. The prevalence of T&CM use ranged from 6% to 100%. Median rates of use were significantly different in LIC/LMIC (66.7% ± 19%), UMIC (60% ± 26%), and HIC (47.2% ± 20%; P = .02). Rates of disclosure differed significantly by country income, with higher median rates in HIC. Seven studies reported on treatment abandonment or delays.ConclusionThe use of T&CM in pediatric oncology is common worldwide, with higher median prevalence of use reported in LIC/LMIC. Further research is warranted to examine the impact on treatment abandonment and delay.

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Section: Discussionmentioning

confidence: 99%

Global Use of Traditional and Complementary Medicine in Childhood Cancer: A Systematic Review

Diorio

Lam

Ladas

et al. 2017

JGO

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“…[28] The cases of J.J. and Makayla Sault set the rights of individuals as Indigenous Peoples to pursue Traditional medicine against the fiduciary duty of healthcare providers to protect children from harm. [29] The interplay between child protection rules as they pertain to medical responsibility and the rights of Indigenous families to choose Indigenous practices was described by ethicist Margaret Somerville as "a world of competing sorrows, because no matter what you do somebody is going to be hurt or harmed or upset". [30] In Canada, a long history of colonialism and post-colonial institutionalized racism has spawned significant mistrust between Indigenous patients and the healthcare and legal systems.…”

Section: Discussionmentioning

confidence: 99%

‘A world of competing sorrows’: A mixed methods analysis of media reports of children with cancer abandoning conventional treatment

et al. 2018

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BackgroundWe aimed to provide health practitioners greater insight into the public perception of traditional and complementary medicine (T&CM) use. Our objectives were to identify news media reports of children abandoning conventional treatment for traditional and complementary medicine, analyze the thematic content of these news articles and estimate the tonality portrayed.MethodsLexisNexis and Factiva were searched for terms related to cancer, children and T&CM. Inclusion criteria were children less than 18 years, in curative phase of treatment who attempted to abandon conventional therapy for any traditional and complementary medicine use. A secondary search was performed in LexisNexis, Factiva and Google News Archive with the names of children in identified cases. Qualitative analysis of news media reports was completed using a grounded theory approach. Quantitative analysis of article sentiment was performed using a linear support vector machine.ResultsSeventeen cases occurring between 2002 and 2016 were included. Five main themes were identified: treatment as torture, power imbalances, rights of parents, evidence versus beliefs and the rights of Indigenous Peoples. Sentiment analysis revealed an overall negative tone, as demonstrated by 73% of the articles.InterpretationA better understanding of factors that lead to abandonment of conventional therapy for traditional and complementary medicine as portrayed in the news media may help healthcare providers prevent the occurrence of these cases.

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“…She was a Canadian First Nation girl whose parents declined further chemotherapy in favour of holistic healing to treat her acute lymphoblastic leukaemia; the courts declined to intervene in the parental decision despite a request from McMaster Children's Hospital staff. 1 In 2014, parents of another Canadian child won a court case to have their son pursue traditional medicine rather than standard treatment, as an Aboriginal right guaranteed under section 35 of the Canadian Constitution. In the past similar court cases have found against the wishes of the families, granting court orders mandating medical treatment.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 There was considerable media and academic coverage criticising these decisions. 1,4,5 Such cases are unique and troubling for many clinicians. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] This study examines a selection of cases where parents and clinicians disagree, using a cultural competence lens.…”

Section: Introductionmentioning

confidence: 99%

(Mis)understandings and uses of ‘culture’ in bioethics deliberations over parental refusal of treatment: Children with cancer

Gray

2017

Clinical Ethics

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We developed this study to examine the issue of parental refusal of treatment, looking at the issue through a cultural competence lens. Recent cases in Canada where courts have declined applications by clinicians for court orders to overrule parental refusal of treatment highlight the dispute in this area. This study analyses the 16 cases of a larger group of 24 cases that were selected by a literature review where cultural or religious beliefs or ethnic identity was described as important reasons behind the refusal. The most significant finding was that nearly all of the cases cited unacceptable side effects as the main reason for declining treatment. We then analysed the detail of the cases and concluded that in the first instance a skilled clinical approach to develop an agreed management plan is by far the best approach. In the event that agreement cannot be reached we recommend engaging a mediator to help the clinician and parents/child to find an agreeable way forward. We argue that the option of seeking a court order was of significant detriment to many of the children in our cases and that this option should be used sparingly. There is a need for empirical research on the outcome of cases where a court order is sought.

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Caring for children, focusing on children

Cited by 4 publications

References 1 publication

Global Use of Traditional and Complementary Medicine in Childhood Cancer: A Systematic Review

Global Use of Traditional and Complementary Medicine in Childhood Cancer: A Systematic Review

‘A world of competing sorrows’: A mixed methods analysis of media reports of children with cancer abandoning conventional treatment

(Mis)understandings and uses of ‘culture’ in bioethics deliberations over parental refusal of treatment: Children with cancer

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