Surgeons' Perceived Barriers to Palliative and End-of-Life Care: A Mixed Methods Study of a Surgical Society

Suwanabol, Pasithorn A.; Reichstein, Ari C.; Suzer‐Gurtekin, Z. Tuba; Forman, Jane; Silveira, Maria J.; Mody, Lona; Morris, Arden M.

doi:10.1089/jpm.2017.0470

Cited by 56 publications

(70 citation statements)

References 46 publications

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“…Adult oncologists refer earlier, when prognosis is < 1 year, for discharge planning, psychosocial and spiritual support. 30 Suwanabol et al (2018) [ 50 ] USA How surgeons who care for patients with colorectal cancers approach end-of-life care and engage palliative care specialists? 131 Cancer Surgeons belonging to the American Society of Colon & Rectal Surgeons Mixed Method Study (Survey + Qualitative Data Analysis) Oncologists have lack of knowledge, training and opportunities for delivery of palliative care.…”

Section: Resultsmentioning

confidence: 99%

“…Uncontrolled symptoms facilitate referral (Rhondali, 2013 [ 45 ]), (Wentlandt, 2012 [ 48 ]), (Wentlandt, 2014 [ 49 ]) (Feld, 2019 [ 55 ]) No referral in the absence of symptoms (Johnson, 2008 [ 40 ]), (Wentlandt, 2014 [ 48 ]) (Feld, 2019 [ 55 ]) No referral until treatment failure or late stage of the disease (LeBlanc, 2015 [ 47 ]). No referral if possibility of cure exists (Johnson, 2008 [ 40 ]) (Wright, 2017 [ 43 ]) (Ethier, 2018 [ 54 ]) Lack of treatment options is a trigger for referral (Feld, 2019 [ 55 ]) Priority on treatment of the disease and cure until the end hinders referral (Morikawa, 2016 [ 39 ]) Difficulty in recommending discontinuation of treatment in younger population (Ethier, 2018 [ 54 ]) Patient and family attitudes Unrealistic expectation of cure and desire for aggressive treatment (Suwanabol, 2018 [ 50 ]) (Horlait, 2016 [ 36 ]) (Ethier, 2018 [ 54 ]) (Cripe, 2019 [ 52 ]) Unwilling to discuss prognosis and non-curative approach (Smith, 2012 [ 44 ]) (Ethier, 2018 [ 54 ]) (Johnson, 2008 [ 40 ]) Unwilling to discuss referral to palliative care (Horlait, 2016 [ 36 ]) (Ward, 2009 [ 41 ]) (Charalambous, 2014 [ 37 ]) (Feld, 2019 [ 55 ]) Family conflict (Suwanabol, 2018 [ 50 ]) Cultural barriers (Suwanabol, 2018 [ 50 ]) (Horlait, 2016 [ 36 ]) Language barriers (Horlait, 2016 [ 36 ]) Negative public perception about death (Suwanabol, 2018 [ 50 ]) Organisational Challenges Hospital culture directed towards cure (Suwanabol, 2018 [ 50 ]), (Horlait, 2016 [ 36 ]) Lack of time to discuss about palliative care (Suwanabol, 2018 [ 50 ]), (Horlait, 2016 [ ...…”

Section: Resultsmentioning

confidence: 99%

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How views of oncologists and haematologists impacts palliative care referral: a systematic review

et al. 2020

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Background Worldwide, many patients with cancer, are infrequently referred to palliative care or are referred late. Oncologists and haematologists may act as gatekeepers, and their views may facilitate or hinder referrals to palliative care. This review aimed to identify, explore and synthesise their views on referrals systematically. Methods Databases of MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, Web of Science and Cochrane were searched for articles from 01/01/1990 to 31/12/2019. All studies were scored for their methodological rigour using Hawker’s tool. Findings were synthesised using Popay’s narrative synthesis method and interpreted using a critical realist lens and social exchange theory. Results Out of 9336 initial database citations, 23 studies were included for synthesis. Five themes were developed during synthesis. 1. Presuppositions of oncologists and haematologists about palliative care referral: Role conflict, abandonment, rupture of therapeutic alliance and loss of hope were some of the presuppositions that hindered palliative care referral. Negative emotions and perception of self-efficacy to manage palliative care need also hindered referral. 2. Power relationships and trust issues: Oncologists and haematologists preferred to gatekeep the referral process and wished to control and coordinate the care process. They had diminished trust in the competency of palliative care providers. 3. Making a palliative care referral: A daunting task: The stigma associated with palliative care, navigating illness and treatment associated factors, addressing patient and family attitudes, and overcoming organisational challenges made referral a daunting task. Lack of referral criteria and limited palliative care resources made the referral process challenging. 4. Cost-benefit of palliative care referral: Pain and symptom management and psychosocial support were the perceived benefits, whereas inconsistencies in communication and curtailment of care were some of the costs associated with palliative care referral. 5. Strategies to facilitate palliative care referral: Developing an integrated model of care, renaming and augmenting palliative care resources were some of the strategies that could facilitate a referral. Conclusion Presuppositions, power relationships, trust issues and the challenges associated with the task of referrals hindered palliative care referral. Oncologists and haematologists appraised the cost-benefit of making a palliative care referral. They felt that an integrated model of care, changing the name of palliative care and augmenting palliative care resources might facilitate a referral.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

How views of oncologists and haematologists impacts palliative care referral: a systematic review

et al. 2020

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“…The majority reported no formal training in palliative care (76.1%) plus unrealistic expectations among families along with cultural barriers to communication. 15…”

Section: Challenges For the Medical Providersmentioning

confidence: 99%

Palliative Care Training for Work in an Austere Environment after a Natural Disaster

Goodman¹,

Black²

2018

Palliat Med Hosp Care Open J

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M.C. was a 79-year-old woman who was rescued from the rubble after being buried for 48 hours after January 12, 2010, Haitian earthquake. She had several fractures of her arms and legs, and extensive crush injuries leading to acute renal failure. Her arms and legs were covered in maggots. She was brought to the United States Field hospital in Port Au Prince. She was awake, confused, and delirious. Any movement caused extreme distress. She was alone. The rescuers could not find any of her family members or friends. After a medical assessment, the team felt that she would not survive her devastating injuries and she was triaged to the expectant category of care. The nursing team placed her in a plastic body bag that was zipped up to her chest to contain the extensive maggot burden on her extremities. An intravenous line was placed in her subclavian vein and morphine was administered every 30 minutes as needed. She was placed in the tent near the team leader station and was checked every 20 minutes. She expired twelve hours after arriving.

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“…After discussions and decisions in the multidisciplinary team (MDT), however, they suggest that incurable cancer is re-evaluated at follow-up, especially after palliative chemotherapy. Incurable colorectal cancer and especially the management of side effects during follow-up give colorectal surgeons inevitable problems and challenges [2]. In their single-centre study, the authors distinguish between patient and disease related reasons for the non-curative fi rst-line treatment of colorectal cancer.…”

Section: Management Of Patients With Incurable Colorectal Cancer: a Rmentioning

confidence: 99%

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2018

Colorectal Disease

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Surgeons' Perceived Barriers to Palliative and End-of-Life Care: A Mixed Methods Study of a Surgical Society

Abstract: Surgeons valued palliative and end-of-life care but reported multilevel barriers to its provision. These data will inform strategies to reduce these perceived barriers.

Cited by 56 publications

References 46 publications

How views of oncologists and haematologists impacts palliative care referral: a systematic review

How views of oncologists and haematologists impacts palliative care referral: a systematic review

Palliative Care Training for Work in an Austere Environment after a Natural Disaster

Issue Information ‐ TOC

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