Palliative care from the perspective of cancer physicians: a qualitative semistructured interviews study

Abstract

ObjectiveIntegrated palliative care for populations with cancer is now highly recommended. However, numerous physicians working in cancer care are still reluctant to refer patients to specialist palliative care teams. This study explores their perceptions of palliative care and factors influencing reasons to refer to specialist palliative care.MethodsWe used a qualitative methodology based on semistructured interviews with physicians working in cancer care, in two tertiary hospitals and one comprehensive cancer centre with access to a specialist palliative care team. Forty-six physicians were invited and 18 interviews were performed until data saturation. Participants were mainly men, licensed in cancer care, 37.9 years old on average and had 13 years of professional experience. The length of interviews was on average 34 min (SD=3). Analysis was performed accordingly with the thematic analysis.ResultsThe data analysis found four themes: symptom management as a trigger, psychosocial support, mediation provided by interventions, and the association with terminal care or death. Palliative care integrated interventions were mainly perceived as holistic approaches that offered symptom management expertise and time. They were valued for helping in consolidating decision-making from a different or external perspective, or an ‘outside look’. Several barriers were identified, often due to the confusion between terminal care and palliative care. This was further highlighted by the avoidance of the words ‘palliative care’, which were associated with death.ConclusionsNational policies for promoting palliative care seemed to have failed in switching oncologists' perception of palliative care, which they still consider as terminal care.

The Effect of Fear of Failure on Confidence in, and Comfortableness With, the Delivery of End-of-life Care

“…Working with others was impacted by the FOF subscale Fear of Devaluing One's Self-Estimate, which is consistent to the literature suggesting that some professionals are reluctant to engage and work with palliative care teams in the care of their patients due to the fear that this indicates the failure of their treatment [24,52]. Given there were not more relationships shown with other FIF subscales might indicate that the 'working with others' questions on the SEPC scale do not accurately measure a person's likelihood to engage a palliative care team, but rather their con dence if they happen to work with other teams.…”

“…Feelings of failure are elicited in clinicians when patients reject treatment, when negotiations fail, or when a patient's body no longer responds to treatment. Failure has been found to be shaped by social and cultural expectations of responsibility; coming both from clinician, peers in medical teams, and patients receiving support [16, 24,36,[50][51][52]. There may be a cyclical effect with FOF in healthcare settings; avoiding patient deaths and EOL discourse may further impede con dence and comfortableness within this area.…”

Physician emotional experience of communication and decision making with end-of-life patients: qualitative studies systematic review

“…Named specialties of participants included physicians from intensive care, oncology, haematology, geriatric medicine, palliative medicine, general medicine, intensive care, surgery, renal medicine, respiratory medicine, cardiology and a pain specialist. One study31 captured data related to the training participants had had in palliative care and EOL communication. It reported that all physicians interviewed over the age of 40 years, which was 5 out of 18 participants, reported never having received training in palliative care.…”

“…Others pointed to the orientation of the researchers, indicating they were explorative,35 or involved psychologists at the interview stage 36. Three papers referred to using prompts to encourage participants to reflect on feelings,31 37 38 and one asked about the meanings they attributed to memorable experiences 39. Six papers were not clear about their method of drawing out emotional experiences from participants.…”

“…One paper simply defined it as expected death within 1 year 41. Two papers asked participants for their perspective,33 36 or to define a set phrase like ‘palliative care’,31 or ‘futility’,38 or ‘end-of-life’ 37 42. Two papers asked participants to recall memorable patient deaths and reflect on those experiences 39 42.…”