Abstract
A large proportion of the morbidity and almost all of the mortality of sickle cell disease (SCD) now occurs in adulthood. Children with SCD underuse disease-modifying and curative treatments, in part because of how patients/parents understand SCD morbidity and mortality. Whether practitioners provide prognostic information to families is unknown. We emailed a 31-item survey to 1,149 pediatric hematologist-oncologists and analyzed 96 responses. Most said discussing prognosis would change patient/parent willingness to start hydroxyurea, but fewer actually discuss prognosis when they want to start hydroxyurea (91% vs. 75%, p=.001). Similarly, most said discussing prognosis would change adherence to therapy, but fewer actually discuss prognosis to motivate adherence (78% vs 31%, p<.001). Most (77%) addressed prognosis when the “patient or their parent bring it up.” Respondents reporting frequent life expectancy discussions were more likely to report a pathway for such discussions (p=.017). Pediatric hematologists may not conduct prognostic discussions without prompting, although these conversations may be important for shared, informed decision-making.
Original language | English (US) |
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Pages (from-to) | 398-423 |
Number of pages | 26 |
Journal | Journal of health care for the poor and underserved |
Volume | 31 |
Issue number | 1 |
DOIs | |
State | Published - Feb 2020 |
Keywords
- Life expectancy
- Prognosis
- Sickle cell anemia
- Sickle cell disease
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health