Perspectives of Hematology Oncology Clinicians about Integrating Palliative Care in Oncology

Booker, Reanne; Dunn, Sharlette; Earp, Madalene A.; Sinnarajah, Aynharan; Biondo, Patricia; Simon, Jessica

doi:10.3747/co.27.6305

Cited by 8 publications

(5 citation statements)

References 37 publications

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“…Tumour specialty was not associated with survey response for any of the five top-ranked challenges ( Table 2 ). Note that GI is the “reference” group to allow comparison to a previously described tumour specialty [ 16 ], and survey results for hematology are published elsewhere [ 27 ].…”

Section: Resultsmentioning

confidence: 99%

Oncology Clinicians’ Challenges to Providing Palliative Cancer Care—A Theoretical Domains Framework, Pan-Cancer System Survey

et al. 2021

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Despite the known benefits, healthcare systems struggle to provide early, integrated palliative care (PC) for advanced cancer patients. Understanding the barriers to providing PC from the perspective of oncology clinicians is an important first step in improving care. A 33-item online survey was emailed to all oncology clinicians working with all cancer types in Alberta, Canada, from November 2017 to January 2018. Questions were informed by Michie’s Theoretical Domains Framework and Behaviour Change Wheel (BCW) and queried (a) PC provision in oncology clinics, (b) specialist PC consultation referrals, and (c) working with PC consultants and home care. Respondents (n = 263) were nurses (41%), physicians (25%), and allied healthcare professionals (18%). Barriers most frequently identified were “clinicians’ limited time/competing priorities” (64%), “patients’ negative perceptions of PC” (63%), and clinicians’ capability to manage patients’ social issues (63%). These factors mapped to all three BCW domains: motivation, opportunity, and capability. In contrast, the least frequently identified barriers were clinician motivation and perceived PC benefits. Oncology clinicians’ perceptions of barriers to early PC were comparable across tumour types and specialties but varied by professional role. The main challenges to early integrated PC include all three BCW domains. Notably, motivation is not a barrier for oncology clinicians; however, opportunity and capability barriers were identified. Multifaceted interventions using these findings have been developed, such as tip sheets to enhance capability, reframing PC with patients, and earlier specialist PC nursing access, to enhance clinicians’ use of and patients’ benefits from an early PC approach.

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Section: Resultsmentioning

confidence: 99%

Oncology Clinicians’ Challenges to Providing Palliative Cancer Care—A Theoretical Domains Framework, Pan-Cancer System Survey

et al. 2021

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“…23,24 Hematology, a specialty closely connected to cancer, delineated challenges to accessing palliative care because of lack of role clarity, timely discussions with patients and early referral, access to information across platforms to enable information sharing, and a lack of recognized triggers for referral. 25 Given these challenges for hematology and cancer patients, all patients with movement disorders who might benefit from palliative care are not always referred to palliative care specialists as evidenced in our survey. Our survey results confirmed a wide variation in opinions on who should initiate discussion about palliative care.…”

Section: Discussionmentioning

confidence: 99%

Access and Attitudes Toward Palliative Care Among Movement Disorders Clinicians

et al. 2021

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Background Neuropalliative care is an emerging field for those with neurodegenerative illnesses, but access to neuropalliative care remains limited. Objective We sought to determine Movement Disorder Society (MDS) members' attitudes and access to palliative care. Methods A quantitative and qualitative survey instrument was developed by the MDS Palliative Care Task Force and e‐mailed to all members for completion. Descriptive statistics and qualitative analysis were triangulated. Results Of 6442 members contacted, 652 completed the survey. Completed surveys indicating country of the respondent overwhelmingly represented middle‐ and high‐income countries. Government‐funded homecare was available to 54% of respondents based on patient need, 25% limited access, and 21% during hospitalization or an acute defined event. Eighty‐nine percent worked in multidisciplinary teams. The majority endorsed trigger‐based referrals to palliative care (75.5%), while 24.5% indicated any time after diagnosis was appropriate. Although 66% referred patients to palliative care, 34% did not refer patients. Barriers were identified by 68% of respondents, the most significant being available workforce, financial support for palliative care, and perceived knowledge of palliative care physicians specific to movement disorders. Of 499 respondents indicating their training in palliative care or desire to learn these skills, 55% indicated a desire to gain more skills. Conclusions The majority of MDS member respondents endorsed a role for palliative care in movement disorders. Many members have palliative training or collaborate with palliative care physicians. Although significant barriers exist to access palliative care, the desire to gain more skills and education on palliative care is an opportunity for professional development within the MDS. © 2021 International Parkinson and Movement Disorder Society

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“…It's possible to intervene on the perception of patients and caregivers, where the "double awareness" (26) of potentially fatal development of the disease and at the same time potentially life- prolonging intervention creates a high stress. For instance, reframing their perception of palliative care through the use of a different term (as "supportive care") (27) or the explanation of a different framework for palliative care for patients with hematologic malignancies as the "CAR(E)" or "Umbrella" model ( 43), or even with an explicit decision to create a higher involvement of the care giver in partial substitution of the patient. It's also possible to increase the self-efficacy of palliative care doctors, through specific hematologic training, considering the specific differences of this patients' population.…”

Section: Refined Theorymentioning

confidence: 99%

Doing palliative care research on hematologic cancer patients: A realist synthesis of literature and experts’ opinion on what works, for whom and in what circumstances

Tanzi

Martucci

2023

Front. Oncol.

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BackgroundResearch in PC (Palliative Care) is frequently challenging for patient’s frailty, study design, professional misconceptions, and so on. Little is known about specificity in PC research on Hematologic cancer patients, who have distinct characteristics that might influence the enrollment process.AimsWhat works, how and for whom, in increasing enrollment in studies in PC on patients with hematologic malignancies?MethodsRealist review: a qualitative review whose goal is to identify and explain the interaction between Contexts, Mechanisms, and Outcomes (CMOs). The theory was informed by a narrative, theory-based literature research, including an initialsystematic research, and the addition of papers suggested by experts of the field. We also used 7 interviews with experts in PC about patients with hematologic malignancies research and our own experience from a PC pilot study on patients with hematologic malignancies to refine the initial theory.ResultsIn our initial theory we hypothesize that: - Access to palliative care could be beneficial to hematologic patients, even in early stages - Hematologists tend to under-use palliative care services in general, due to unpredictable disease trajectories and cultural barriers. - These factors may negatively impact the patients’ enrollment in PC researchWe included secondary literature as narrative reviews, if they presented interesting propositions useful for our theoretical construction. 23 papers met our inclusion criteria.We also searched for relevant CMOs impacting referral in palliative care, and we selected a list of CMOs that could be relevant also in hematology. We accordingly theorized a group of interventions that could increase the enrollment in PC research and presented them using “social exchange theory” (SET) as a theoretical framework.Prominent researchers in PC in hematologic malignancies were interviewed on their opinion on our results, and additional CMOs.ConclusionsBefore conducting research in PC on patients with hematologic malignancies, it’s probably advisable to assess: - The perception of the different actors (physicians, nurses, other professionals involved), in particular the hematologists, in terms of pros and cons of referral to PC and enrollment in PC trials - The existing relationship between PC and the Hematology departmentAccordingly, it’s possible to tailor different interventions on the various actors and choose a model of trial to increase the perception of benefits from PC and, consequently, enrollment.

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Perspectives of Hematology Oncology Clinicians about Integrating Palliative Care in Oncology

Cited by 8 publications

References 37 publications

Oncology Clinicians’ Challenges to Providing Palliative Cancer Care—A Theoretical Domains Framework, Pan-Cancer System Survey

Oncology Clinicians’ Challenges to Providing Palliative Cancer Care—A Theoretical Domains Framework, Pan-Cancer System Survey

Access and Attitudes Toward Palliative Care Among Movement Disorders Clinicians

Doing palliative care research on hematologic cancer patients: A realist synthesis of literature and experts’ opinion on what works, for whom and in what circumstances

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