Presuppositions, cost–benefit, collaboration, and competency impacts palliative care referral in paediatric oncology: a qualitative study

Abstract

Background Although a significant proportion of children with cancer need palliative care, few are referred or referred late, with oncologists and haematologists gatekeeping the referral process. We aimed to explore the facilitators and barriers to palliative care referral. Methods Twenty-two paediatric oncologists and haematologists were purposively recruited and interviewed. Data were analysed using reflexive thematic analysis. Findings were interpreted using the critical realist paradigm. Results Four themes were generated. 1) Oncologists expressed concern about the competency of palliative care teams. Palliative care often symbolised therapeutic failure and abandonment, which hindered referral. Trustworthy palliative care providers had clinical competence, benevolence, and knowledge of oncology and paediatrics. 2) Making a palliative care referral was associated with stigma, navigating illness-related factors, negative family attitudes and limited resources, impeding palliative care referral. 3) There were benefits to palliative care referral, including symptom management and psychosocial support for patients. However, some could see interactions with the palliative care team as interference hindering future referrals. 4) Suggested strategies for developing an integrated palliative care model include evident collaboration between oncology and palliative care, early referral, rebranding palliative care as symptom control and an accessible, knowledgeable, and proactive palliative care team. Conclusion Presuppositions about palliative care, the task of making a referral, and its cost-benefits influenced referral behaviour. Early association with an efficient rebranded palliative care team might enhance integration.

Oncologists' Palliative Care Referral Behaviour: Testing Utility of Social Exchange Theory as an Explanatory Framework

“…However, none of these studies was conducted in a cancer care setting. In this study, we tested the utility of social exchange theory as a framework for explaining oncologists' referral behaviour in a cancer palliative care setting using a systematic review (54) and original research (55) conducted by the authors of this paper.…”

“…Steps 4,5, and 6: Determining measures for Hypothesis Testing, Data Collection and Analysis In this step, the hypothesis was tested using a systematic review (54) and original research (55) conducted by the authors of this paper. The data collection and analysis of these two measures are described below.…”

“…The subsequent qualitative study (55) was conducted with a research question: What are the views of oncologists and haematologists on what facilitates or hinders the referral of a child with advanced cancer to palliative care? Twenty-two eligible oncologists and haematologists managing children with cancer were purposively recruited from 13 tertiary cancer centres.…”

“…The ndings of the systematic review (54) and the original research (55), used to test the hypothesis, were interpreted using the tenets of social exchange theory.…”

“…The study (55) brought out benevolence as a facet of trustworthiness. Benevolence corresponds to doing good and being kind (76).…”