Palliative care utilization in oncology and hemato-oncology: a systematic review of cognitive barriers and facilitators from the perspective of healthcare professionals, adult patients, and their families

Bennardi, Marco; Diviani, Nicola; Gamondi, Claudia; Stüssi, Georg; Saletti, Piercarlo; Cinesi, Ivan; Rubinelli, Sara

doi:10.1186/s12904-020-00556-7

Cited by 80 publications

(71 citation statements)

References 85 publications

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“…One might assume that these factors work as barriers to change, as well as to interprofessional collaborations. 16 Third, closely linked to the organizational challenges were a number of critical appraisals to colleagues in other professions and positions. In general, an insufficient level of communication and collaboration upward in the hierarchy appeared to be a challenge, which is also reported elsewhere.…”

Section: Discussionmentioning

confidence: 99%

“…34,35 Knowledge of each other and available arenas to meet are two organizational-related factors that could be facilitators. 16,20 However, the current view on self and other HCPs seems to be a barrier that needs to be taken into account. For example, the oncologists neither experienced a great need for improved collaboration with palliative care services nor identified a need for earlier referrals of ''their'' patients.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 Early integration of oncology and palliative care has, however, proved challenging to implement due to several barriers. [14][15][16] These barriers include doubts about the usefulness and importance of palliative care among oncologists, insufficient collaboration between various health care professions, noninvolvement of patients in decisions of care, the misunderstanding of palliative care as end-of-life care only, and insufficient organizational factors. 14,15,[17][18][19][20][21] Owing to these and potential other barriers, implementation of coordinated integrated care for patients with advanced cancer may represent a demanding task for HCPs.…”

Section: Introductionmentioning

confidence: 99%

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Challenges and Learning Needs for Providers of Advanced Cancer Care: Focus Group Interviews with Physicians and Nurses

Lundeby

Wester

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et al. 2020

Palliative Medicine Reports

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Background: Implementation of integrated oncology and palliative care improves patient outcomes but may represent a demanding task for health care providers (HCPs). Objective: To explore physicians' and nurses' perceived challenges and learning needs in their care for patients with advanced cancer, and to analyze how these perceptions can provide insight on how to improve care for patients with advanced cancer in an integrated care model. Methods: Residents in oncology, oncologists, nurses, and palliative care physicians were recruited to participate in focus group interviews. Six focus group interviews were conducted with 35 informants. Data were analyzed according to principles of thematic analysis. Results: The discussions in the interviews concerned three broad themes: an emphasis on patients' best interest, perceived as hindered by two sets of barriers; unsatisfactory organizational conditions such as time pressure, lack of referral routines, and few arenas for interdisciplinary collaboration, was perceived as one barrier. The other barrier was related to the appraisal of other HCPs' clinical practices. Participating HCPs expressed in general a positive self-view, but were more critical of other HCPs. Conclusion: Currently, implementation of measures to improve care for patients with advanced cancer appears to be challenging due to cultural and organizational factors, and how HCPs perceive themselves and other HCPs. HCPs' perception of challenges in patient care as not related to themselves (externalization) might be an essential obstacle. Interventions targeting both HCP-related and organizational factors are needed. Particularly important are measures aimed at reducing fragmentation and improving collaboration in care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Challenges and Learning Needs for Providers of Advanced Cancer Care: Focus Group Interviews with Physicians and Nurses

Lundeby

Wester

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et al. 2020

Palliative Medicine Reports

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“…Thus, whether the decision-makers are the patients or their families can be a factor affecting the prognosis. Although previous studies have revealed the factors associated with difficulty and burden of the decision-making process, [ 22 , 23 ] it has been unclear to what extent the patient's self-decisions influenced the prognostic period. Information about how the survival period and palliative care would be affected by cancer treatment terminated by patients themselves, as compared to treatments terminated by the family, will lead to better decision-making support regarding the termination of cancer treatment.…”

Section: Introductionmentioning

confidence: 99%

Impact of self-decision to stop cancer treatment on advanced genitourinary cancer patients

et al. 2021

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Decision-making to stop cancer treatment in patients with advanced cancer is stressful, and it significantly influences subsequent end-of-life palliative treatment. However, little is known about the extent to which the patient's self-decisions influenced the prognostic period. This study focused on the patient's self-decision and investigated the impact of the self-decision to stop cancer treatment on their post-cancer treatment survival period and place of death. We retrospectively analyzed 167 cases of advanced genitourinary cancer patients (kidney cancer: 42; bladder cancer: 68; prostate cancer: 57) treated at the University of Fukui Hospital (UFH), who later died because of cancer. Of these, 100 patients decided to stop cancer treatment by themselves (self-decision group), while the families of the remaining 67 patients (family's decision group) decided to stop treatment on their behalf because the patient's decision-making ability was already impaired. Differences in the post-cancer-treatment survival period and place of death between the 2 groups were examined. The association between place of death and survival period was also analyzed. The median survival period after terminating cancer treatment was approximately 6 times longer in the self-decision group (145.5 days in self-decision group vs 23.0 days in family's decision group, P < .001). Proportions for places of death were as follows: among the self-decision group, 42.0% of patients died at UFH, 45.0% at other medical institutions, and 13.0% at home; among the family's decision group, 62.7% died at UFH, 32.8% at other medical institutions, and 4.5% at home. The proportion of patients who died at UFH was significantly higher among the family's decision group ( P = .011). The median survival period was significantly shorter for patients who died at UFH (UFH: 30.0 days; other institutions/home: 161.0 days; P < .001). Significantly longer post-cancer-treatment survival period and higher home death rate were observed among patients whose cancer treatment was terminated based on their self-decision. Our results provide clinical evidence, especially in terms of prognostic period and place of death that support the importance of discussing bad news, such as stopping cancer treatment with patients.

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“…Em tempos de pandemia, pode-se dizer que o adoecido limita sua relação com o mundo social um pouco mais do que já vivenciado. Em revisão sistemática sobre as repercussões do câncer entre profissionais de saúde, paciente e familiares, o elemento "comunicação" foi evidenciado por facilitar a translação de informações entre as pessoas e reduzir diversas barreiras criadas durante o processo de adoecimento 5 , como a barreira social.…”

Section: Introductionunclassified

Câncer em tempos de COVID-19: repercussões na vida de mulheres em tratamento oncológico

et al. 2020

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Objetivo: compreender a vivência do enfrentamento e repercussões da COVID-19, na percepção de mulheres em tratamento oncológico. Método: estudo qualitativo, do tipo ação-participante, fundamentado no Itinerário de Pesquisa de Paulo Freire, que possui três fases: Investigação Temática; Codificação e Descodificação; Desvelamento Crítico. Foi realizado Círculo de Cultura virtual, com a participação de 12 mulheres em tratamento do câncer de mama, de diferentes localidades do Brasil. Resultados: no Círculo de Cultura virtual discutiram dois temas: desafios no enfrentamento do câncer e da COVID-19; aprendizados gerados nessa vivência, considerando um renascimento das próprias cinzas. Considerações finais: o momento pandêmico tem instigado reflexões sobre o viver. Assim, as mulheres em tratamento oncológico e também em restrição social puderam expressar seus sentimentos, descobrindo e redescobrindo fragilidades e fortalezas para ressignificar e crescer como seres, em uma sociedade, que pode e deve articular estratégias para promoção da saúde.

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Palliative care utilization in oncology and hemato-oncology: a systematic review of cognitive barriers and facilitators from the perspective of healthcare professionals, adult patients, and their families

Cited by 80 publications

References 85 publications

Challenges and Learning Needs for Providers of Advanced Cancer Care: Focus Group Interviews with Physicians and Nurses

Challenges and Learning Needs for Providers of Advanced Cancer Care: Focus Group Interviews with Physicians and Nurses

Impact of self-decision to stop cancer treatment on advanced genitourinary cancer patients

Câncer em tempos de COVID-19: repercussões na vida de mulheres em tratamento oncológico

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