What are the barriers faced by medical oncologists in initiating discussion of palliative care? A qualitative study in Flanders, Belgium

Horlait, Melissa; Chambaere, Kenneth; Pardon, Koen; Deliëns, Luc; Belle, Simon Van

doi:10.1007/s00520-016-3211-5

Cited by 77 publications

(138 citation statements)

References 23 publications

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“…Barriers reported by oncologists such as feelings of failure and close personal bonds with patients, 21 were not found, suggesting that some aspects of the experience of PAs were more similar to bedside nurses’ experience than to the physicians’ experience, although their clinical role in the hospital is more similar to that of the physician. In contrast to other studies, patient and family difficulty understanding information, poor health literacy, or resistance to discussing difficult topics did not emerge as major themes.…”

Section: Discussionmentioning

confidence: 85%

“…All clinicians face communication barriers caused by limited time, unpredictable work load and family conflict. 21,25–27 However, PAs have the added burden of role ambiguity. This is important because provision of care perceived to be futile, coupled with a belief that their communication skills are inadequate, is associated with PA burnout.…”

Section: Discussionmentioning

confidence: 99%

“…21–25 In addition, physicians have cited time constraints and patient and family fears, emotions and lack of knowledge as barriers. 21,26,27 They have also cited their own emotional bonds with patients and feelings of failure. 21 In contrast, bedside nurses identified unclear communication roles and difficulty prognosticating as barriers.…”

Section: Introductionmentioning

confidence: 99%

“…21,26,27 They have also cited their own emotional bonds with patients and feelings of failure. 21 In contrast, bedside nurses identified unclear communication roles and difficulty prognosticating as barriers. 25 …”

Section: Introductionmentioning

confidence: 99%

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“I Just Felt Like I Was Stuck in the Middle”: Physician Assistants' Experiences Communicating With Terminally Ill Patients and Their Families in the Acute Care Setting

Chuang

Lamkin

Hope

et al. 2017

Journal of Pain and Symptom Management

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Context Terminally ill hospitalized patients and their families consistently rank effective communication and shared decision-making among their top priorities. Advance Practice Providers such as Physician Assistants (PAs) are increasingly providing care in the hospital setting and are often called to communicate with patients and families. A first step to improving PA communication is to better understand PAs’ current experiences in their daily practices. Objectives This study aimed to explore: 1) roles PAs serve in communicating with terminally ill patients/families; 2) PAs’ attitudes and opinions about communication roles and 3) perceived barriers and facilitators of communication with patients/families in the hospital setting. Methods Five focus groups were conducted with PAs practicing on adult medical services at three acute care hospitals of an academic medical center in the Bronx, NY. An open-ended question guide was used. An inductive thematic analysis strategy was used to examine the data from transcribed audiotapes of focus group sessions to identify emergent concepts and themes. Results The overarching theme that emerged was being Stuck in the Middle. PAs experienced 1) ambiguity around their roles and responsibilities in communications between the medical team and patients and families; 2) gaps in knowledge and skills and 3) organizational or structural deficits in the patient care systems that placed them in uncomfortable situations. Conclusion Interventions aimed at improving PA communication with terminally ill patients and their families should target institutional structures, systems and culture around roles and responsibilities in addition to skill and knowledge gaps in order to be most effective.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

“I Just Felt Like I Was Stuck in the Middle”: Physician Assistants' Experiences Communicating With Terminally Ill Patients and Their Families in the Acute Care Setting

Chuang

Lamkin

Hope

et al. 2017

Journal of Pain and Symptom Management

View full text Add to dashboard Cite

show abstract

“…This is where various initiatives such as advance care planning come into play, also emphasizing the role of the general practitioner in acknowledging the patient’s wishes at an early stage of the disease [3]. As many physicians feel uncomfortable initiating discussion about end-of-life measures, these initiatives become even more important [38–41]. …”

Section: Discussionmentioning

confidence: 99%

Survey on German Palliative Care Specialists’ Experiences with Advance Directives

Zenz

2016

Pain Ther

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IntroductionAdvance directives (AD) play a central role in end-of-life treatments, intensive care, and palliative care. However, little is known about the experiences of healthcare professionals with ADs. This study reports on palliative care professionals’ views on advance directives (AD).MethodsA questionnaire was handed out to attendants of a palliative care symposium.ResultsComplete answers were obtained from 126 physicians and 276 nurses. Almost all physicians and nurses had treated patients with an AD, and the majority more than 10 patients. The most frequent refusal by the patients was resuscitation (87.8%) followed by intensive care (79.1%), artificial ventilation, and nutrition. The most frequent wish was pain therapy (92.3%) followed by allowing the natural course of the illness (64.4%). The wish for hospice treatment (44.8%) or spiritual care (39.3%) was less frequent.DiscussionThe results hint at fears and deficits in the care of patients at the end of life. Often the quality of life and not the quantity of days remaining is in the center of a patient’s will and points to the growing importance of palliative care.ConclusionADs are well established among palliative care professionals and regarded as helpful for patients at the end of life.

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Timing of Palliative Care Referral Before and After Evidence from Trials Supporting Early Palliative Care

et al. 2021

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Background Evidence from randomized controlled trials has demonstrated benefits in quality of life outcomes from early palliative care concurrent with standard oncology care in patients with advanced cancer. We hypothesized that there would be earlier referral to outpatient palliative care at a comprehensive cancer center following this evidence. Materials and Methods Administrative databases were reviewed for two cohorts of patients: the pre‐evidence cohort was seen in outpatient palliative care between June and November 2006, and the post‐evidence cohort was seen between June and November 2015. Timing of referral was categorized, according to time from referral to death, as early (>12 months), intermediate (>6 months to 12 months), and late (≤6 months from referral to death). Univariable and multivariable ordinal logistic regression analyses were used to determine demographic and medical factors associated with timing of referral. Results Late referrals decreased from 68.8% pre‐evidence to 44.8% post‐evidence; early referrals increased from 13.4% to 31.1% (p < .0001). The median time from palliative care referral to death increased from 3.5 to 7.0 months (p < .0001); time from diagnosis to referral was also reduced (p < .05). On multivariable regression analysis, earlier referral to palliative care was associated with post‐evidence group (p < .0001), adjusting for shorter time since diagnosis (p < .0001), referral for pain and symptom management (p = .002), and patient sex (p = .04). Late referrals were reduced to <50% in the breast, gynecological, genitourinary, lung, and gastrointestinal tumor sites. Conclusions Following robust evidence from trials supporting early palliative care for patients with advanced cancer, patients were referred substantially earlier to outpatient palliative care. Implications for Practice Following published evidence demonstrating the benefit of early referral to palliative care for patients with advanced cancer, there was a substantial increase in early referrals to outpatient palliative care at a comprehensive cancer center. The increase in early referrals occurred mainly in tumor sites that have been included in trials of early palliative care. These results indicate that oncologists’ referral practices can change if positive consequences of earlier referral are demonstrated. Future research should focus on demonstrating benefits of early palliative care for tumor sites that have tended to be omitted from early palliative care trials.

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What are the barriers faced by medical oncologists in initiating discussion of palliative care? A qualitative study in Flanders, Belgium

Cited by 77 publications

References 23 publications

“I Just Felt Like I Was Stuck in the Middle”: Physician Assistants' Experiences Communicating With Terminally Ill Patients and Their Families in the Acute Care Setting

“I Just Felt Like I Was Stuck in the Middle”: Physician Assistants' Experiences Communicating With Terminally Ill Patients and Their Families in the Acute Care Setting

Survey on German Palliative Care Specialists’ Experiences with Advance Directives

Timing of Palliative Care Referral Before and After Evidence from Trials Supporting Early Palliative Care

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