Early parental knowledge of late effect risks in children with cancer

BACKGROUND/OBJECTIVES

Despite the pervasiveness of late effects in childhood cancer survivors, many parents feel inadequately informed about their child's risks. We assessed early parental knowledge of risks of late effects and predictors of increased knowledge.

DESIGN/METHODS

Parents of children receiving cancer treatment at Dana-Farber/Boston Children's Cancer and Blood Disorders Center were surveyed about their knowledge of their child's likelihood of eight late effects. Individual risk for each late effect (yes/no) was assessed using the Children's Oncology Group's Long-Term Follow-Up Guidelines v5 as a reference. Descriptive statistics were used to summarize knowledge scores; ordinal logistic regression was used to identify predictors of higher knowledge.

RESULTS

Of 96 parent participants, 11 (11.46%) correctly identified all of their child's risks for the eight late effects. Five of eight was the median number of correctly identified late effect risks. Among 21 parents whose children were at risk for ototoxicity, 95% correctly identified this risk. Conversely, parents of at-risk children were less knowledgeable about risks of secondary malignancy (63% correct identification, of N = 94 at risk), cardiac toxicity (61%; N = 71), neurocognitive impairment (56%; N = 63), and infertility (28%; N = 61). Ordinal logistic regression analysis identified no significant differences in parental knowledge of late effect risks by any factors evaluated.

CONCLUSIONS

Gaps in parental knowledge of potential late effects of childhood cancer treatment emerge early in a child's care, and parents are more knowledgeable about some late effects, such as ototoxicity, than others, such as infertility. As no child- or parent-specific factors were associated with increased knowledge of late effect risks, interventions must be applied broadly.

The new trustee. In a transformed healthcare system, board members will have to expand their skills

In a future that will involve new accountabilities, greater risks, and more adaptability, board members must learn to function well at three levels: They must retain the grand vision of what their organization can be. Their strategies must be effective enough to enable them to win more battles than they lose. They must oversee without meddling, approve without operating, and steward their resources with care and compassion for their institution's employees and patients. The financial pressures that exist at every level of our operations can make it difficult for board members to keep focused on their institution's mission. Board members must also grapple with increased government intervention, blurred institutional boundaries, more powerful insurers, and conflicts between institutions and physicians. To perform well in such an environment, board members must focus on their unique role in institutional governance. In addition, they must understand the organization's mission, be aware of the changes brought about by new financial incentives for providers, learn to work well with diverse institutions, and understand the concerns of physicians in a changing healthcare scene. Trustees must also be aware that changing goals and incentives will require healthcare providers to adopt a new, prevention-oriented approach to healthcare delivery.