Purpose: We explored pediatricians’ practices and attitudes concerning end-of-life discussions (EOLds) with pediatric patients with cancer, and identified the determinants of pediatricians’ positive attitude toward having EOLds with pediatric patients. Methods: A multicenter questionnaire survey was conducted with 127 pediatricians specializing in the treatment of pediatric cancer. Results: Forty-two percent of participants reported that EOLds should be held with the young group of children (6–9 years old), 68% with the middle group (10–15 years old), and 93% with the old group (16–18 years old). Meanwhile, 6, 20, and 35% of participants answered that they “always” or “usually” discussed the incurability of the disease with the young, middle, and old groups, respectively
for the patient’s imminent death, the rates were 2, 11, and 24%. Pediatricians’ attitude that they “should have” EOLds with the young group was predicted by more clinical experience (odds ratio [OR] 1.077
p = 0.007), more confidence in addressing children’s anxiety after EOLd (OR 1.756
p = 0.050), weaker belief in the demand for EOLd (OR 0.456
p = 0.015), weaker belief in the necessity of the EOLd for children to enjoy their time until death (OR, 0.506
p = 0.021), and weaker belief in the importance of maintaining a good relationship with the parents (OR 0.381
p = 0.025). Conclusions: While pediatricians nearly reached consensus on EOLds for the old group, EOLds with the young group remain a controversial subject. While pediatricians who supported EOLds believed in their effectiveness or necessity, those who were against EOLds tended to consider the benefits of not engaging in them.