Palliative Cancer Care a Decade Later: Accomplishments, the Need, Next Steps—From the American Society of Clinical Oncology

Ferris, Frank D.; Bruera, Éduardo; Cherny, Nathan I.; Cummings, Charmaine; Currow, David C.; Dudgeon, Deborah; Janjan, Nora A.; Strasser, Florian; Gunten, Charles F. von; Roenn, Jamie H. Von

doi:10.1200/jco.2008.20.1558

Cited by 345 publications

(265 citation statements)

References 34 publications

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“…Despite ACGME requirements for the inclusion in the fellowship curriculum of palliative care, many oncology fellows still do not feel comfortable with EOL care 14 and oncologists in general do not have adequate training in communication skills and psychosocial care. [15][16][17][18] Cultural differences between older and younger physicians may be present as societal changes take place through the years.…”

Section: Discussionmentioning

confidence: 99%

Palliative Care Training during Fellowship: A National Survey of U.S. Hematology and Oncology Fellows

Thomas

Curley

Wen

et al. 2015

Journal of Palliative Medicine

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Background: Despite requirements for palliative care training during fellowship, there is a paucity of recent data regarding the attitudes, knowledge, and skills of hematology/ oncology fellows in palliative care. Objective: Our aim was to assess fellows' attitudes toward and quality of training in palliative care during fellowship and perceived preparedness to care for patients at the end of life (EOL). Methods: In May 2013 a cross-sectional survey of hematology/oncology fellows was conducted. Results: Fellows from 93 of 138 fellowship programs responded (67.4%). Of the 347 fellows e-mailed, 176 participated. Nearly all fellows (99%) indicated that physicians have a responsibility to help patients at EOL. Fellows felt their overall training in fellowship was superior to training in EOL care (4.24 -0.78 versus 3.53 -0.99 on a 5-5 scale where 1 = poor and 5 = excellent, p < 0.0001). Fellows who had a rotation in palliative care during fellowship (44.9%) reported better teaching on managing a patient at EOL than those who did not (3.91 -1.0 versus 3.21 -0.87, p < 0.0001). Fellows reporting better teaching in EOL care felt better prepared to care for patients at EOL (r = 0.52, p < 0.0001). More than 25% reported not being explicitly taught how to assess prognosis, when to refer a patient to hospice, or how to conduct a family meeting to discuss treatment options. Conclusion: Many recent oncology fellows are still inadequately prepared to provide palliative care to their patients. There is significant room for improvement with regards to the quality of palliative care training in U.S. hematology/oncology fellowship programs.

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Section: Discussionmentioning

confidence: 99%

Palliative Care Training during Fellowship: A National Survey of U.S. Hematology and Oncology Fellows

Thomas

Curley

Wen

et al. 2015

Journal of Palliative Medicine

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“…All interviews were audiotaped and transcribed using a professional transcription service, before being verified by a research assistant.The NVivo software program, version 8,2009, was used to facilitate management and analysis of qualitative data (QSR International, Doncaster, Australia, http://www.qsrinternational.com).…”

Section: Qualitative Analysismentioning

confidence: 99%

“…Palliative care services are well-placed to address those needs; however, referrals to palliative care are typically made late in the illness trajectory [3,4]. A substantial body of quantitative evidence now supports the merits of early palliative care (EPC) for patients with advanced cancer, including improvements in quality of life, mood, satisfaction with care, symptom burden, and, in some cases, survival [5][6][7].Thus, early integration of palliative care into oncology care is recommended as the standard of care by an increasing number of international cancer organizations [8][9][10], with a shift in focus to how EPC can best be achieved [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Early Palliative Care and Its Role in Oncology: A Qualitative Study

et al. 2016

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Introduction. Early integration of palliative care alongside oncology is being increasingly recommended, although the strategies and models for integration remain poorly defined. We solicited the opinions of patients and caregivers who participated in a randomized trial of early palliative care versus standard oncology care, regarding the respective roles of their oncologist (both groups) and palliative care physician (early palliative care group). Materials and Methods. The study was performed at a comprehensive cancer center. Forty-eight patients (26 intervention, 22 control) and 23 caregivers (14 intervention, 9 control) were recruited purposefully at trial end. One-on-one, semistructured qualitative interviews were conducted and analyzed using grounded theory. Results. The themes resulting from the analysis fell into three categories: the focus of care, the model of care delivery, and the complementarity between teams. The focus of care in

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“…At first, such care does not exclude specific antineoplastic therapies. 24,25 However, we see that the referral of patients to PC services has occurred repeatedly in the late stages of the disease, representing a major barrier to access in many parts of the world. 26,27 The finding that few cancer patients treated at the ER were in PC or HC promoted a discussion among professionals of the institution in order to create expansion strategies.…”

Section: Discussionmentioning

confidence: 99%

Cancer patients, emergencies service and provision of palliative care

Miranda

Vidal

Mello

et al. 2016

Rev. Assoc. Med. Bras.

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Objective: To describe the clinical and sociodemographic profile of cancer patients admitted to the Emergency Center for High Complexity Oncologic Assistance, observing the coverage of palliative and home care. Method: Cross sectional study including adult cancer patients admitted to the emergency service (September-December/2011) with a minimum length of hospital stay of two hours. Student's t-test and Pearson chi-square test were used to compare the means. Results: 191 patients were enrolled, 47.6% elderly, 64.4% women, 75.4% from the city of Recife and greater area. The symptom prevalent at admission was pain (46.6%). 4.2% of patients were linked to palliative care and 2.1% to home care. The most prevalent cancers: cervix (18.3%), breast (13.6%) and prostate (10.5%); 70.7% were in advanced stages (IV, 47.1%); 39.4% without any cancer therapy. Conclusion: Patients sought the emergency service on account of pain, probably due to the incipient coverage of palliative and home care. These actions should be included to oncologic therapy as soon as possible to minimize the suffering of the patient/family and integrate the skills of oncologists and emergency professionals.

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Palliative Cancer Care a Decade Later: Accomplishments, the Need, Next Steps—From the American Society of Clinical Oncology

Abstract: The need for palliative cancer care is greater than ever notwithstanding the strides made over the last decade. Further efforts are needed to realize the integration of palliative care in the model and vision of comprehensive cancer care by 2020.

Cited by 345 publications

References 34 publications

Palliative Care Training during Fellowship: A National Survey of U.S. Hematology and Oncology Fellows

Palliative Care Training during Fellowship: A National Survey of U.S. Hematology and Oncology Fellows

Early Palliative Care and Its Role in Oncology: A Qualitative Study

Cancer patients, emergencies service and provision of palliative care

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