Factors Modifying Decision-Making at Diagnosis of Advanced Childhood Cancer in Low- and Middle-Income Countries (RP223)

Outcomes 1. Participants will be able to describe challenges physicians practicing in low-and middle-income countries face, when making treatment decisions for children presenting with advanced cancer, as well as the factors that modify treatment recommendations.2. Participants will be able to suggest interventions or future studies that will help support physicians and other decision-makers in low-and middle-income countries when determining treatment plans for children presenting with advanced cancer. Key Message Physicians in LMICs face challenging cancer-related decision-making, including whether to recommend curative versus non-curative therapies at diagnosis to children presenting with advanced disease. Existing protocols do not consistently provide guidance on how to navigate these decisions. This exploratory work will inform future studies aimed at improving childhood cancer outcomes. Importance Physicians in low- and middle-income countries (LMICs) face challenging cancer-related decision-making, including whether to recommend curative versus non-curative therapies at diagnosis to children presenting with advanced cancer. Objective(s) In this study, we sought to understand physician decision-making approaches and factors that modify treatment recommendations at diagnosis for these children in LMICs. Scientific Methods Utilized Semi-structured interviews were conducted with physicians who treat children diagnosed with cancer across six World Health Organization (WHO) defined regions. Interviews were conducted using an online platform, audio-recorded, and transcribed. The research team developed a hybrid inductive/deductive codebook utilizing an existing framework describing factors influencing treatment decision-making and applied codes across transcripts. Thematic content analysis focused on decision-making approaches. Results Thirty-six physicians completed interviews. Preliminary analysis describes decision-making processes with initial treatment recommendations based on static factors considered for all patients, including the diagnosis and disease burden. Many physicians described their inability to offer cure-directed treatment at diagnosis. Treatment recommendations were modified at two points: 1) prior to and 2) during or after the discussion with the patient/family. Dynamic factors that altered an initial recommendation included resource and treatment availability and allocation, treatment affordability, and family alignment or disagreement with the treatment recommendation. Conclusion(s) Treatment decision-making for children presenting with advanced cancer in LMICs is not linear, and curative treatments cannot always be offered. Impact Revision of treatment guidelines for use in resource-constrained settings which incorporate challenges faced and factors that modify decision-making in the context of advanced disease at diagnosis is required. Future work will explore the perspectives and decision-making approaches of patients/families to inform intervention design to support decision-making, including the provision of upfront non-curative treatment strategies and early integration of palliative care. This abstract was completed on behalf of the CATALYST Study Group. Keywords Qualitative and mixed methods research/Pediatrics