Collaborating or co-existing: a survey of attitudes of medical oncologists toward specialist palliative care

Abstract

Patients with advanced cancer often have complex care needs requiring collaboration between medical oncology and palliative care providers. Little is known about how effective and acceptable such collaboration is to medical oncologists. Attitudes of Australian medical oncologists toward collaboration with specialist palliative care services were investigated using a Web-based survey. Descriptive statistics and attitude indices were calculated and a thematic content analysis performed. One hundred and fifteen respondents (78 medical oncologists, 37 trainees) completed the survey (response rate 30.3%). Positive attitudes toward specialist palliative care involvement were expressed with most respondents preferring concurrent rather than sequential models of care (94.8%, n = 109). Reported barriers to collaboration included reluctance for referral by patients (minor 60.9%, n = 70; major 8.7%, n = 10) or families (minor 67%, n = 77; major 7%, n = 8), a lack of inpatient beds (minor 27%, n = 31; major 34.8%, n = 40) and inadequate resources for specialist palliative care to take some referrals (minor 30.4%, n = 35; major 30.4%, n = 35). There was no difference in attitude indices for those who had completed a palliative care rotation during their training (33%, n = 38) and those who had not. Suggestions for improvement in collaboration focused around four areas - improved resources, improved multidisciplinary links, mutual respect and understanding, and consistency in service provision. This study is the first to specifically investigate the views of Australian medical oncologists toward collaboration with specialist palliative care. While positive attitudes have been expressed, identified barriers to collaboration need attention.

Palliative Care Consultations in Patients With Cancer: A Mayo Clinic 5-Year Review

“…15 This progressive delay may reflect a hardening of a biased belief that palliative care and end-of-life care are synonymous, a misunderstanding that is still observed in surveys of health care providers regarding attitudes 22 and practice patterns. 23 Moreover, the role of palliative care professionals may still be perceived as involving end-of-life care only. Fewer than half of polled oncologists feel adequately trained to perform palliative care tasks, although they report feeling comfortable addressing common symptoms found in advanced cancer.…”

Is patient information on palliative care good enough? A literature review and audit

“…Health professionals felt palliative care needed to be more integrated into oncology practice and most supported a model where the two services ran concurrently (Ward et al, 2009, Chasen et al, 2015. Some health professionals felt that changing the name of the service to supportive care would make them more likely to refer at an earlier stage (Wentlandt et al, 2012, Wentlandt et al, 2014, Hui et al, 2015.…”

“…The lack of clear referral pathways often meant that health professionals were hesitant in making a referral as they were unsure of the steps they should follow (Keim-Malpass et al, 2015). In some cases, palliative care services were simply not available (Charalambous et al, 2014) or the available palliative care service was not sufficient to meet the level of demand therefore only patients in serious need of palliative care support would be referred (Ward et al, 2009, Keim-Malpass et al, 2015.…”

Developing a “toolkit” to measure implementation of concurrent palliative care in rural community cancer centers

“…Tool development began with a literature review of studies and tools related to perceptions of and referral barriers to oncology palliative care (Bradley et al, 2002;Cherny et al, 2003;Cherny & Palliative Care Working Group of the European Society for Medical Oncology, 2011;Fox et al, 2007;Johnson et al, 2008;Metzger et al, 2013;Ogle et al, 2002;Sheetz & Bowman, 2008;Ward et al, 2009;Wotton et al, 2005 Palliative care implementation toolkit ranged from not relevant (1) to very relevant and succinct (4) (Lynn, 1986). Items were revised based on reviewer feedback, focusing on items that received an average content validity score of 3 or greater.…”