Doctors' understanding of palliative care

Abstract

Palliative care has been challenged to share its message with a wider audience, and for many years it has been articulating an approach that is suitable for all patients. However, it is not clear how widely this message has been accepted. As part of a study into end-of-life care for heart failure, we conducted seven focus groups with doctors in general practice, palliative medicine, cardiology, geriatrics and general medicine. In these, we explored doctors' understanding of palliative care. Participants displayed a reasonable grasp of the wider concept of palliative care, but the specialists' role was ill-defined, reflected in scepticism about their place outside of cancer. Perceptions of palliative care fell into three broad areas: it was more than a service, about managing dying, and the concern of nurses, rather than doctors. Palliative care was welcomed as providing permission to fail, whilst representing a dilemma between quantity and quality of life for the interviewees. Our work suggests that specialist palliative care has been partially successful in getting their message across, and poor understanding or receptivity are not major barriers to implementing palliative care. Educational or other interventions to implement change in palliative care need to acknowledge the complex interaction of factors influencing physicians' behaviour.

Perceptions of palliative care among patients with advanced cancer and their caregivers

“…physicians and nurses, who tended to associate palliative care with terminal care, 10,12 voiced confusion about the role of specialized palliative care, 10,12 and felt the term palliative care decreased hope and caused distress in patients and families. 8 Our study contributes the important perspective of patients and their caregivers, including those who received early palliative care.…”

“…31,32 Among referring physicians there is variable awareness or acceptance of the new broadened definition of palliative care, with many continuing to equate palliative care with end-of-life care. 8,11,12 In our study, participants' perceptions of palliative care were derived in large part from contact with the medical system. It is therefore important that physicians and other health care professionals are familiar with the broadened definition of palliative care and are able to explain it to their patients.…”

“…6,7 Negative attitudes toward palliative care among patients and caregivers are often cited by physicians as a reason for late referrals to palliative care services, 6,8 and a change of name to "supportive care" has been proposed. 8,9 Although some studies have reported on attitudes of oncologists and other physicians toward palliative care and its name, 6,8,[10][11][12] there has been scant research on the perspectives of patients and caregivers. Previous surveys of patients and/or caregivers have solicited opinions about either the quality of palliative care received 13,14 or about the acceptability of the name "palliative care" versus "supportive care" for those who might be referred.…”

Barriers to accessing palliative care: A review of the literature

“…Non-cancer illnesses are usually less likely to access PC services. (10,(16)(17)(18)(19)(20)(21)(22)(23) For example, patients with chronic obstructive pulmonary disease are less likely to access the services because discussion of end of life care is often delayed. (16,18,23) Factors attributed to doctors and health professionals Doctors play an integral part in providing links with palliative care services.…”

Efetividade de duas modalidades de equipe de cuidado no controle de sintomas em pacientes com câncer avançado

“…Estudos prévios consideram o termo "palliative care" confuso para médicos e pacientes [45][46][47] .…”