Characterizing the Role of U.S. Surgeons in the Provision of Palliative Care: A Systematic Review and Mixed-Methods Meta-Synthesis

Suwanabol, Pasithorn A.; Kanters, Arielle; Reichstein, Ari C.; Wancata, Lauren M.; Dossett, Lesly A.; Rivet, Emily B.; Silveira, Maria J.; Morris, Arden M.

doi:10.1016/j.jpainsymman.2017.11.031

Cited by 52 publications

(51 citation statements)

References 66 publications

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“…Physician barriers include: decreased buy‐in and subsequent lack of referral to palliative care, desire to continue managing long‐term patients, and underexposure to the role and scope of palliative care in training . Additionally, many surgeons that do refer patients to palliative care report difficulties introducing these concepts to patients . Inherent to physician barriers are incomplete knowledge or inaccurate beliefs about the role and timing of palliative care, which is appropriate throughout the course of a potentially life‐limiting disease .…”

Section: Discussionmentioning

confidence: 99%

Palliative care use amongst patients with bladder cancer

et al. 2019

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ObjectivesTo describe the rate and determinants of palliative care use amongst Medicare beneficiaries with bladder cancer and encourage a national dialogue on improving coordinated urological, oncological, and palliative care in patients with genitourinary malignancies. Patients and methodsUsing Surveillance, Epidemiology, and End Results-Medicare data, we identified patients diagnosed with muscle-invasive bladder cancer (MIBC) between 2008 and 2013. Our primary outcome was receipt of palliative care, defined as the presence of a claim submitted by a Hospice and Palliative Medicine subspecialist. We examined determinants of palliative care use using logistic regression analysis. ResultsOver the study period, 7303 patients were diagnosed with MIBC and 262 (3.6%) received palliative care. Of 2185 patients with advanced bladder cancer, defined as either T4, N + , or M + disease, 90 (4.1%) received palliative care. Most patients that received palliative care (>80%, >210/262) did so within 24 months of diagnosis. On multivariable analysis, patients receiving palliative care were more likely to be younger, female, have greater comorbidity, live in the central USA, and have undergone radical cystectomy as opposed to a bladder-sparing approach. The adjusted probability of receiving palliative care did not significantly change over time. ConclusionsPalliative care provides a host of benefits for patients with cancer, including improved spirituality, decrease in diseasespecific symptoms, and better functional status. However, despite strong evidence for incorporating palliative care into standard oncological care, use in patients with bladder cancer is low at 4%. This study provides a conservative baseline estimate of current palliative care use and should serve as a foundation to further investigate physician-, patient-, and system-level barriers to this care.Keywords urinary bladder neoplasms, palliative care, palliative medicine, cystectomy, quality of health care, health services research, Medicare, #BladderCancer, #blcsm

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Section: Discussionmentioning

confidence: 99%

Palliative care use amongst patients with bladder cancer

et al. 2019

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“…It would be interesting to interview physicians who do not include IPCC in their daily practice for their reasons in a further study, including a focus on different specialties, since surgical disciplines are underrepresented. Interestingly there is data, which shows that surgical specialties experience less education in palliative care and therefore feel uncomfortable addressing it [51]. The interviews were conducted in a rather long period of time (19 interviews in 17 months); so that there could be a change of interviewees' perception of IPCC additional to a maybe adjusted established practice in their daily work concerning PC patients.…”

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

Impact, challenges and limits of inpatient palliative care consultations – perspectives of requesting and conducting physicians

Coym

Kanitz

Puls

et al. 2020

BMC Health Serv Res

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Background: Inpatient palliative care consultation (IPCC) teams have been established to improve care for patients with specialist palliative care (PC) needs throughout all hospital departments. The objective is to explore physicians' perceptions on the impact of IPCC, its triggers, challenges and limits, and their suggestions for future service improvements. Methods: A Qualitative study drawing on semi-structured interviews with 10 PC specialists of an IPCC team and nine IPCC requesting physicians from oncology and non-oncological departments of a university hospital. Analysis was performed using qualitative content analysis. Results: PC specialists and IPCC requesting physicians likewise considered organization of further care and symptom-burden as main reasons for IPCC requests. The main impact however was identified from both as improvement of patients' (and their caregivers') coping strategies and relief of the treating team. Mostly, PC specialists emphasized a reduction of symptom burden, and improvement of further care. Challenges in implementing IPCC were lack of time for both. PC specialists addressed requesting physicians' skepticism towards PC. Barriers for realization of IPCC included structural aspects for both: limited time, staff capacities and setting. PC specialists saw problems in implementing recommendations like disagreement towards their suggestions. All interviewees considered education in PC a sensible approach for improvement. Conclusions: IPCC show various positive effects in supporting physicians and patients, but are also limited due to structural problems, lack of knowledge, insecurity, and skepticism by the requesting physicians. To overcome some of these challenges implementation of PC education programs for all physicians would be beneficial.

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“…Some of our participants experienced the first information about their incurable disease as delayed, insufficient, given in an inappropriate way or at an inappropriate place. This indicates that there is a need for increased focus on communication by HCPs both during their university studies and in hospitals 8. Furthermore, it would be desirable for surgeons to have more time allocated to conveying information and communicating with patients.…”

Section: Discussionmentioning

confidence: 99%

“…HCPs also need to be aware of how much information each patient prefers and discuss this with the patient. Previous studies have shown that this awareness is associated with years of practice and confidence 8 10. Treatment and care of patients undergoing palliative chemotherapy should be organised in such a way that patients are able to see the same well-qualified physician and optionally also the same nurses at each consultation.…”

Section: Discussionmentioning

confidence: 99%

“…Guidelines encourage healthcare professionals (HCPs) such as physicians and nurses to keep patients informed and to discuss their prognoses and likely future prospects. However, many HCPs and patients struggle to find the right approach for these discussions,5–9 and a primary focus on open communication regarding the bleak prospects for the patient’s life expectancy entails a risk of overwhelming the individual’s need for information and their hope 10…”

Section: Introductionmentioning

confidence: 99%

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Reflections on communication of disease prognosis and life expectancy by patients with colorectal cancer undergoing palliative care: a qualitative study

2019

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ObjectivesPatients with colorectal cancer undergoing palliative treatment receive extensive treatment-related information throughout their disease trajectory. We aimed to explore the experiences of patients with incurable colorectal cancer while in palliative care and their reflections on the information provided by physicians and nurses. Our main focus was the patients’ thoughts about how information about disease status and life expectancy was communicated, from the first time that they were informed about the incurable nature of their disease through to postsurgery palliative treatment.SettingsPatients with colorectal cancer receiving palliative chemotherapy.Research designWe used a qualitative approach, and the data were analysed by qualitative content analysis.Participants20 patients (34–75 years of age) were included in the study; 12 received first-line chemotherapy and 8 received second-line chemotherapy. Eleven patients were treated by oncologists, and nine were treated by junior physicians.ResultsData-driven empirical analysis identified three themes: (1) inadequate information during the initial phase of the disease trajectory; (2) hope and information further into the disease trajectory and (3) personal, professional and organisational factors that influenced information and communication throughout the disease trajectory.ConclusionThe participants’ experience of being told for the first time that they had an incurable disease was perceived as inadequate, while postsurgery palliative chemotherapy, physicians and nurses offered hope. The participants preferred customised information about their treatment and likely future prospects and physicians and nurses who took a holistic and compassionate approach focusing on their lifeworld. To be a sensitive, holistic and compassionate physician or nurse requires knowledge and confidence. To achieve this requires training and guidance at universities and in hospitals.

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Characterizing the Role of U.S. Surgeons in the Provision of Palliative Care: A Systematic Review and Mixed-Methods Meta-Synthesis

Cited by 52 publications

References 66 publications

Palliative care use amongst patients with bladder cancer

Palliative care use amongst patients with bladder cancer

Impact, challenges and limits of inpatient palliative care consultations – perspectives of requesting and conducting physicians

Reflections on communication of disease prognosis and life expectancy by patients with colorectal cancer undergoing palliative care: a qualitative study

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