Originally published as JCO Early Release 10.1200/JCO.2008.21.2506 on February 23 2009

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In Reply

Department of Pediatric Oncology and Center for Outcomes and Policy Research, Dana-Farber Cancer Institute; and Department of Medicine, Children's Hospital, Boston, MA

Jane C. Weeks

Department of Medical Oncology and Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA

Joanne Wolfe

Department of Pediatric Oncology and Center for Outcomes and Policy Research, Dana-Farber Cancer Institute; and Department of Medicine, Children's Hospital, Boston, MA

We would like to thank Dickens and Nicholls for their interest in our study¹ and for their thoughtful comments. We agree with Dickens and Nicholls that there are many possible explanations for our findings. We have raised the possibility of parental regret as only one hypothesis, but an important one, because it may have implications for physician communication about cancer-directed therapy when cure is not possible. In our report, we also speculate about other possible explanations, including changes during the bereavement period in parental values regarding care and the inherent limitations of a study that is based on vignettes. Dickens and Nicholls have provided additional compelling hypotheses and considerations.

We appreciate the opportunity to engage in conversation on this topic and to think carefully about clinical implications. Because little literature about parental decision making in the end-of-life period is available, this correspondence also serves to underscore the critical importance of additional research in this area. Our hypotheses as researchers and readers are important, but ongoing research will allow parents to teach us about their experiences themselves.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

REFERENCES

1. Mack JW, Joffe S, Hilden JM, et al: Parents' views of cancer-directed therapy for children with no realistic chance for cure. J Clin Oncol 26:4759–4764, 2008.[Abstract/Free Full Text]

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