METHODS: The Assessing Doctors' Attitudes on Palliative Treatment survey was revised for cultural context, translated into six languages, and distributed electronically to physicians who care for children with cancer. Descriptive statistics were used to summarize data. Secondary analyses used the Pearson chi-square test or Fisher exact test to examine associations between prior PC training and physician subspecialty with reported barriers. The McNemar test was applied to evaluate differences between actual versus ideal timing of PC consultations. Analysis of variance was conducted to compare mean values for perceived barriers across country income levels.

RESULTS: Six hundred twenty-one physicians from 18 countries participated, with an overall response rate of 27% (621/2,305) and a median country response rate of 30% (range, 11%-85%). Most respondents (n = 366; 59%) believed PC should be consulted at diagnosis, but only 18% (n = 117) stated that this occurred in their clinical setting (P < .001). The most highly ranked barriers to PC provision included limited physician knowledge (n = 511; 82%), lack of national health policy/advocacy (n = 494; 79%), lack of PC-trained clinicians (n = 492; 79%), lack of home-based services (n = 487; 78%), and physician discomfort in discussing PC (n = 483; 78%). Physicians practicing in lower-middle-income countries rated these barriers more significantly.

METHODS: The validated Assessing Doctors' Attitudes on Palliative Treatment survey was modified for use in AP, translated into six languages, and adapted for cultural relevance. The survey was distributed electronically between February 2022 and February 2024 to physicians caring for children with cancer in 18 AP countries. The primary outcome was alignment with WHO PC guidance, calculated as a mean percentage per physician. Secondary analyses explored associations between demographic variables and WHO alignment scores using regression analyses. Open-ended responses were analyzed qualitatively.

RESULTS: A total of 621 physicians from 18 countries participated (median country response rate 30%; range, 11%-85% per country). Most (70%; n = 432) had >10 years of clinical experience and no prior PC training (65%; n = 401). Although 57% (n = 352) had access to pediatric PC experts, only 50% (n = 308), 36% (n = 221), 27% (n = 166), and 34% (n = 209) expressed comfort addressing patient/family physical, emotional, spiritual, and grief/bereavement needs, respectively. Additionally, 40% (n = 248) reported feeling burdened addressing end-of-life suffering. The mean alignment with WHO guidance was 76% (range, 48%-92%). Almost all (>90%; n = 570) desired further PC training.