Practice Patterns, Attitudes, and Barriers to Palliative Care Consultation by Gynecologic Oncologists

Meritens, Alexandre Buckley de; Margolis, Benjamin; Blinderman, Craig D.; Prigerson, Holly G.; Maciejewski, Paul K.; Shen, Megan Johnson; Hou, June Y.; Burke, William M.; Wright, Jason D.; Tergas, Ana I.

doi:10.1200/jop.2017.021048

Cited by 38 publications

(34 citation statements)

References 31 publications

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“…[162][163][164][165][166][167][168][169][170][171][172] Oncologists' end of life care attitudes can influence their timely palliative care referral and end of life cancer treatment decisions. There is evidence that oncologists often refer patients late in the course of illness, 166,167,[173][174][175][176] despite believing, as found in recent surveys, that integration of early specialist palliative care in cancer improves symptom control, end-of-life care, health-related communication, and continuity of care. 173,176 A survey of 182 oncologists in the USA from a major cancer centre, found that comfort with the concepts of end of life care was associated with higher rates of specialist palliative care referral and self-reported primary palliative care delivery.…”

Section: Introductionmentioning

confidence: 99%

Integration of oncology and palliative care: a Lancet Oncology Commission

Kaasa

Loge

Aapro

et al. 2018

The Lancet Oncology

511

539

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Presence of palliative care inpatient consultation team Presence of palliative care outpatient clinic Presence of community based / home palliative care Clinical processes (*) Presence of multidisciplinary specialized palliative care team Routine symptom screening in the outpatient oncology clinic Administration of systemic cancer therapy (e.g. chemo and targeted agents) possible in patients admitted to PC service oncology-and palliative care as well as their cultures. Local variations in terms of resources and practices also probably play a role. By acknowledging integration of oncology and PC as a complex process including different parts of the health care system, both horizontally and vertically, and also involving the patient, we propose SCPs as a means for future efforts to promote integration. For the same reasons, this paper will address integration in different panels. Each panel will address different aspects of integration, ranging from how to focus on the patient, to societal changes and new research areas. Introduction of panels Policy-challenges and frameworks Societal challenges Prognostication Patient-centredness-content methodology and clinical implications Models of palliative care integration The role of education: challenges and recommendations Research The commission is an international collaboration between 30 experts in oncology, PC, public health and psycho-oncology. In October 2016 a kick-off meeting was held in Milan where panel leaders were appointed, the structure of the commission was decided, and a plan for the work was agreed upon. During the two following years each panel expanded with experts within the relevant field, conducted topical literature searches, and an interactive writing process was conducted. Both administrative and academic organization were run from Norway, by Stein Kaasa, Jon Håvard Loge and Tonje Lundeby. Policy-challenges and frameworks Questions to be addressed What type of recommendations is given for integration at the national and international level on policy and public health at present? What are the current examples of different practices in organization of palliative care in different national policies in European countries? What kind of policies and approaches are needed for integration of oncology and palliative care? Patient-centredness-content, methodology and clinical implications Questions to be addressed What is patient-centredness? What are the main elements of patient-centred care in practice? How do we involve the family? Communication-a necessary tool for patient-centred care What are the barriers and solutions to succeed? Research Questions to be addressed What are some opportunities and challenges for integrating oncology and palliative care teams to conduct research together? What are some key research priorities related to integration of palliative care and oncology? What are some key research priorities related to symptom assessment and treatment? What are some key research priorities related to psychosocial support, communication and dec...

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Section: Introductionmentioning

confidence: 99%

Integration of oncology and palliative care: a Lancet Oncology Commission

Kaasa

Loge

Aapro

et al. 2018

The Lancet Oncology

511

539

View full text Add to dashboard Cite

show abstract

“…In fact, when patients, families, and clinicians discuss referrals to specialty palliative care, the elephant in the room is a collective fear that there could be tradeoffs between length and quality of life [17]. Patients, families, and clinicians often view palliative care as synonymous with, if not fostering, death, characterizing it variously as the grim reaper service [18,19], giving up [20,21], abandonment [22,23], death row [24], and a death panel [25,26]. Consequently, most referrals to outpatient specialty palliative care occur late in the disease course, if at all, and underutilization harms quality of life [15,[27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Impact of Interdisciplinary Outpatient Specialty Palliative Care on Survival and Quality of Life in Adults With Advanced Cancer: A Meta-Analysis of Randomized Controlled Trials

Hoerger

Wayser

Schwing

et al. 2018

Annals of Behavioral Medicine

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Background In advanced cancer, patients want to know how their care options may affect survival and quality of life, but the impact of outpatient specialty palliative care on these outcomes in cancer is uncertain. Purpose To estimate the impact of outpatient specialty palliative care programs on survival and quality of life in adults with advanced cancer. Methods Following PRISMA guidelines, we conducted a systematic review and meta-analysis of randomized controlled trials comparing outpatient specialty palliative care with usual care in adults with advanced cancer. Primary outcomes were 1 year survival and quality of life. Analyses were stratified to compare preliminary studies against higher-quality studies. Secondary outcomes were survival at other endpoints and physical and psychological quality-of-life measures. Results From 2,307 records, we identified nine studies for review, including five high-quality studies. In the three high-quality studies with long-term survival data (n = 646), patients randomized to outpatient specialty palliative care had a 14% absolute increase in 1 year survival relative to controls (56% vs. 42%, p < .001). The survival advantage was also observed at 6, 9, 15, and 18 months, and median survival was 4.56 months longer (14.55 vs. 9.99 months). In the five high-quality studies with quality-of-life data (n = 1,398), outpatient specialty palliative care improved quality-of-life relative to controls (g = .18, p < .001), including for physical and psychological measures. Conclusions Patients with advanced cancer randomized to receive outpatient specialty palliative care lived longer and had better quality of life. Findings have implications for improving care in advanced cancer.

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“…A recent survey of Gynecologic Oncologists also found similar concerns regarding patient perceptions of palliative involvement. 14 Beliefs and perspectives of PCS were not discussed in either of these studies.…”

Section: Discussionmentioning

confidence: 98%

Burn Surgeon and Palliative Care Physician Attitudes Regarding Goals of Care Delineation for Burned Geriatric Patients

Cunningham

Scielzo

Nakonezny

et al. 2018

Journal of Burn Care &Amp; Research

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Palliative care specialists (PCS) and burn surgeons (BS) were surveyed regarding: 1) importance of goals of care (GoC) conversations for burned seniors; 2) confidence in their own specialty's ability to conduct these conversations; and 3) confidence in the ability of the other specialty to do so. A 13-item survey was developed by the steering committee of a multicenter consortium dedicated to palliative care in the injured geriatric patient and beta-tested by BS and PCS unaffiliated with the consortium. The finalized instrument was electronically circulated to active physician members of the American Burn Association and American Academy for Hospice and Palliative Medicine. Forty-five BS (7.3%) and 244 PCS (5.7%) responded. Palliative physicians rated being more familiar with GoC, were more comfortable having a discussion with laypeople, were more likely to have reported high-quality training in performing conversations, believed more palliative specialists were needed in intensive care units, and had more interest in conducting conversations relative to BS. Both groups believed themselves to perform GoC discussions better than the other specialty perceived them to do so. BS favored leading team discussions, whereas palliative specialists preferred jointly led discussions. Both groups agreed that discussions should occur within 72 hours of admission. Both groups believe themselves to conduct GoC discussions for burned seniors better than the other specialty perceived them to do so, which led to disparate views on perceptions for the optimal leadership of these discussions.

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Practice Patterns, Attitudes, and Barriers to Palliative Care Consultation by Gynecologic Oncologists

Abstract: The majority of gynecologic oncologists perceived palliative care as a useful collaboration that is underused. Fear of perceived abandonment by the patient and family members was identified as a significant barrier to palliative care consult.

Cited by 38 publications

References 31 publications

Integration of oncology and palliative care: a Lancet Oncology Commission

Integration of oncology and palliative care: a Lancet Oncology Commission

Impact of Interdisciplinary Outpatient Specialty Palliative Care on Survival and Quality of Life in Adults With Advanced Cancer: A Meta-Analysis of Randomized Controlled Trials

Burn Surgeon and Palliative Care Physician Attitudes Regarding Goals of Care Delineation for Burned Geriatric Patients

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