What do transplant physicians think about palliative care? A national survey study

Abstract

Background Despite its established benefits, palliative care (PC) is rarely utilized for hematopoietic stem cell transplant (HSCT) patients. We sought to examine transplant physicians’ perceptions of PC. Methods We conducted a cross-sectional survey of transplant physicians recruited from the American-Society-for-Blood-and-Marrow-Transplantation. Using a 28-item questionnaire adapted from prior studies, we examined physicians’ access to PC services, and perceptions of PC. We computed a composite score of physicians’ attitudes about PC (mean=16.9, SD=3.37) and explored predictors of attitudes using a linear mixed model. Results 277/1005 (28%) of eligible physicians completed the questionnaire. The majority (76%) stated that they trust PC clinicians to care for their patients, but 40% felt that PC clinicians do not have enough understanding to counsel HSCT patients about their treatments. Most endorsed that when patients hear the term PC, they feel scared (82%) and anxious (75%). Nearly half (45%) reported that the service name ‘palliative care’ is a barrier to utilization. Female sex (β=0.85, P=0.024), having <10 years of clinical practice (β=1.39, P=0.004), and perceived quality of PC services (β=0.60, P<0.001) were all associated with a more positive attitude towards PC. Physicians with a higher sense of ownership over their patients’ PC issues (β=−0.36, P <0.001) were more likely to have a negative attitude towards PC. Conclusions The majority of transplant physicians trust PC, but have substantial concerns about PC clinicians’ knowledge about HSCT and patients’ perception of the term ‘palliative care’. Interventions are needed to promote collaboration, improve perceptions, and enhance integration of PC for HSCT recipients.

Physicians’ Perspectives on Palliative Care for Patients With End‐Stage Liver Disease: A National Survey Study

“…First, with a response rate of 32%, our survey may be subject to nonresponse bias, and given the overrepresentation of physicians primarily practicing at teaching hospitals, our results might not be generalizable to nonacademic settings. However, our response rate is comparable to those reported in other contemporary electronic clinician survey studies . Second, although the survey items were validated in prior studies, we adapted these items to apply specifically to patients with ESLD, and this instrument should be validated in future studies of patients with liver disease.…”

“…Our results show that physicians have different attitudes about PC referrals for patients with ESLD based on their candidacy for liver transplantation. These findings suggest a misperception among physicians that the delivery of PC begins when active therapy ends, which is a noted barrier to PC referral in other transplant populations . However, in addition to their complex medical needs, patients on the transplant list also have significant psychosocial needs, specifically related to coping and uncertainty while awaiting transplantation, for which PC referrals could provide much‐needed support .…”

“…Our secondary analysis was aimed at examining predictors of physicians’ attitudes about PC. As has been done in prior studies, we generated a composite score for our primary outcome of interest: physicians’ attitudes about PC based on the 6 survey items within this domain . Each of these items was scored on a 4‐point Likert scale, and we created a composite score of all 6 items (with higher scores indicating more positive attitudes about PC; range, 4‐24).…”

“…Each of these items was scored on a 4‐point Likert scale, and we created a composite score of all 6 items (with higher scores indicating more positive attitudes about PC; range, 4‐24). We also generated composite scores corresponding to other survey domains that we defined a priori as potential predictors of physicians’ attitudes about PC: Perception that ESLD is a terminal condition (scored as a yes/no item). Extent of collaboration with PC services (higher scores indicating more frequent collaboration with PC services; range, 0‐6). Perceived quality of PC services (higher scores indicating higher perceived quality of PC services; range, 0‐6). Attitudes about PC for liver transplant candidates (higher scores indicating more positive attitudes about PC for liver transplant candidates; range, 0‐15). Perception of patients’ reactions to PC (higher scores indicating a more positive perception of patients’ reactions to PC; range, 3‐21). Sense of ownership over addressing PC issues (higher scores indicating a higher sense of ownership; range, 2‐18). …”

“…Despite evidence supporting the benefit of PC for many chronic conditions, PC remains underused for patients with ESLD . We hypothesize that misperceptions of PC may contribute to the underutilization of specialty PC services by physicians caring for patients with ESLD, as has been shown in prior studies of providers caring for patients with cancer and congestive heart failure . However, we currently have limited empirical data on the perceptions of PC by physicians providing care to patients with ESLD .…”