The Perspectives of Oncology Healthcare Providers on the Role of Palliative Care in a Comprehensive Cancer Center

Overview

Journal BMC Palliat Care

Publisher Biomed Central

Specialty Critical Care

Date 2022 Aug 23

PMID 35999560

Authors

Trenley M Anderson

Megan M Farrell

Gabriel Moss

Mona Gupta

Stefanie Mooney

Katherine Daunov

Megan Savernick

Jan Frandsen

Kolby Verrona

Aryn Pecoraro

Cassandra Mance

Jorge Garcia

Richard T Lee

Affiliations

Soon will be listed here.

Abstract

Background: Palliative care (PC) is an essential part of oncologic care, but its optimal role within a cancer center remains unclear. This study examines oncology healthcare providers' perspectives about the role of PC at a comprehensive cancer center (CCC).

Methods: Physicians, nurses, and other oncology healthcare providers at a CCC were surveyed for their opinions about the role of inpatient and outpatient PC, preferences for PC services, and barriers to referral. Chi-squared tests and multiple regression analyses were performed to explore associations.

Results: We received 137/221 completed questionnaires (61% response rate). Respondents were generally female (78%), had ≤ 10 years of service (69%), and included physicians (32%), nurses (32%), and advanced practice providers (17%). Most respondents (82%) agreed that more patients could benefit from PC. They also agreed that PC is beneficial for both outpatient and inpatient management of complex pain (96 and 88%), complex symptoms (84 and 74%), and advanced cancer patients (80 and 64%). Transition to hospice (64 vs. 42%, p = 0.007) and goals of care (62 vs. 49%, p = 0.011) provided by PC services were more valued by respondents for the inpatient than for the outpatient setting. Barriers to utilizing PC included lack of availability, unsure of when to refer, and poor communication. The majority of respondents (83%) preferred a cancer focused PC team to provide high-quality care.

Conclusions: Overall, the majority of oncology health care providers believe that more patients could benefit from PC, but opinions vary regarding the roles of inpatient and outpatient PC. Barriers and areas for improvement include availability, referral process, and improved communication.

Citing Articles

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References

Suwanabol P, Reichstein A, Suzer-Gurtekin Z, Forman J, Silveira M, Mody L . Surgeons' Perceived Barriers to Palliative and End-of-Life Care: A Mixed Methods Study of a Surgical Society. J Palliat Med. 2018; 21(6):780-788. PMC: 6909736. DOI: 10.1089/jpm.2017.0470. View

Charalambous H, Pallis A, Hasan B, OBrien M . Attitudes and referral patterns of lung cancer specialists in Europe to Specialized Palliative Care (SPC) and the practice of Early Palliative Care (EPC). BMC Palliat Care. 2015; 13(1):59. PMC: 4279692. DOI: 10.1186/1472-684X-13-59. View

Aldridge M, Hasselaar J, Garralda E, van der Eerden M, Stevenson D, McKendrick K . Education, implementation, and policy barriers to greater integration of palliative care: A literature review. Palliat Med. 2015; 30(3):224-39. DOI: 10.1177/0269216315606645. View

Hui D, Bruera E . Models of integration of oncology and palliative care. Ann Palliat Med. 2015; 4(3):89-98. DOI: 10.3978/j.issn.2224-5820.2015.04.01. View

Achora S, Labrague L . An Integrative Review on Knowledge and Attitudes of Nurses Toward Palliative Care: Implications for Practice. J Hosp Palliat Nurs. 2019; 21(1):29-37. DOI: 10.1097/NJH.0000000000000481. View

Ferrell B, Temel J, Temin S, Alesi E, Balboni T, Basch E . Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2016; 35(1):96-112. DOI: 10.1200/JCO.2016.70.1474. View

Smith C, Nelson J, Berman A, Powell C, Fleischman J, Salazar-Schicchi J . Lung cancer physicians' referral practices for palliative care consultation. Ann Oncol. 2011; 23(2):382-7. PMC: 3265546. DOI: 10.1093/annonc/mdr345. View

Temel J, Greer J, Muzikansky A, Gallagher E, Admane S, Jackson V . Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010; 363(8):733-42. DOI: 10.1056/NEJMoa1000678. View

Wentlandt K, Krzyzanowska M, Swami N, Rodin G, Le L, Zimmermann C . Referral practices of oncologists to specialized palliative care. J Clin Oncol. 2012; 30(35):4380-6. DOI: 10.1200/JCO.2012.44.0248. View

10.

Feld E, Singhi E, Phillips S, Huang L, Shyr Y, Horn L . Palliative Care Referrals for Advanced Non-small-cell Lung Cancer (NSCLC): Patient and Provider Attitudes and Practices. Clin Lung Cancer. 2019; 20(3):e291-e298. DOI: 10.1016/j.cllc.2019.02.002. View

11.

Lange M, Thom B, Kline N . Assessing nurses' attitudes toward death and caring for dying patients in a comprehensive cancer center. Oncol Nurs Forum. 2008; 35(6):955-9. DOI: 10.1188/08.ONF.955-959. View

12.

Johnson C, Girgis A, Paul C, Currow D . Cancer specialists' palliative care referral practices and perceptions: results of a national survey. Palliat Med. 2008; 22(1):51-7. DOI: 10.1177/0269216307085181. View

13.

Pinto E, Marcos G, Walters C, Goncalves F, Sacarlal J, Castro L . Palliative care in Mozambique: Physicians' knowledge, attitudes and practices. PLoS One. 2020; 15(8):e0238023. PMC: 7446778. DOI: 10.1371/journal.pone.0238023. View

14.

Berendt J, Stiel S, Simon S, Schmitz A, van Oorschot B, Stachura P . Integrating Palliative Care Into Comprehensive Cancer Centers: Consensus-Based Development of Best Practice Recommendations. Oncologist. 2016; 21(10):1241-1249. PMC: 5061542. DOI: 10.1634/theoncologist.2016-0063. View

15.

Ahmed N, Bestall J, Ahmedzai S, Payne S, Clark D, Noble B . Systematic review of the problems and issues of accessing specialist palliative care by patients, carers and health and social care professionals. Palliat Med. 2004; 18(6):525-42. DOI: 10.1191/0269216304pm921oa. View

16.

Ward A, Agar M, Koczwara B . Collaborating or co-existing: a survey of attitudes of medical oncologists toward specialist palliative care. Palliat Med. 2009; 23(8):698-707. DOI: 10.1177/0269216309107004. View

17.

Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A . Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014; 383(9930):1721-30. DOI: 10.1016/S0140-6736(13)62416-2. View

18.

Dans M, Kutner J, Agarwal R, Baker J, Bauman J, Beck A . NCCN Guidelines® Insights: Palliative Care, Version 2.2021. J Natl Compr Canc Netw. 2021; 19(7):780-788. PMC: 10196810. DOI: 10.6004/jnccn.2021.0033. View

19.

Hui D, Cerana M, Park M, Hess K, Bruera E . Impact of Oncologists' Attitudes Toward End-of-Life Care on Patients' Access to Palliative Care. Oncologist. 2016; 21(9):1149-55. PMC: 5016076. DOI: 10.1634/theoncologist.2016-0090. View

20.

Cripe J, Mills K, Kuroki L, Wan L, Hagemann A, Fuh K . Gynecologic Oncologists' Perceptions of Palliative Care and Associated Barriers: A Survey of the Society of Gynecologic Oncology. Gynecol Obstet Invest. 2018; 84(1):50-55. DOI: 10.1159/000491089. View