TY - JOUR
T1 - Factors Influencing Head and Neck Surgical Oncologists' Transition from Curative to Palliative Treatment Goals
AU - Liao, Kershena
AU - Blumenthal-Barby, Jennifer
AU - Sikora, Andrew G.
N1 - Publisher Copyright:
© 2017 Official journal of the American Academy of Otolaryngology-Head and Neck Surgery Foundation.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Objective The factors influencing head and neck surgical oncologists' goals of care and decisions to initiate conversations about transitioning to palliative-intent treatment for patients with limited curative treatment options are incompletely understood. Lack of guidance for physicians on this topic can lead to inconsistent utilization of palliative services, as well as confusing, upsetting experiences for patients and families. We review the literature investigating the clinical factors, inter- and intrapersonal factors, and financial and health care system considerations that head and neck cancer physicians weigh during this decision-making process. Data Sources PubMed. Review Methods Selected literature on head and neck surgical oncologists' decision making in end-of-life care and palliative therapy was reviewed and analyzed thematically. Conclusions Physicians taking into account patients' clinical trajectories often overestimate the negative impact of head and neck cancer symptoms on their quality of life, suggesting that patients' expectations of quality of life should be discussed early, before communication barriers arise. How head and neck clinicians perceive and are influenced by patients' desired degree of autonomy, which varies greatly depending on the severity of illness, is still unclear. Patients' financial and insurance status affects decision making about hospice care. Finally, physician demographics (eg, age, subspecialization, practice setting), emotions, and philosophical background may exert unconscious biases that have not been fully determined for head and neck surgical oncologists. Implications for Practice A more comprehensive understanding of the head and neck surgical oncologist's approach toward considering a transition to therapy with palliative intent may help guide advancements in this complex counseling process, leading to improvements in patient care, quality of life, and outcomes.
AB - Objective The factors influencing head and neck surgical oncologists' goals of care and decisions to initiate conversations about transitioning to palliative-intent treatment for patients with limited curative treatment options are incompletely understood. Lack of guidance for physicians on this topic can lead to inconsistent utilization of palliative services, as well as confusing, upsetting experiences for patients and families. We review the literature investigating the clinical factors, inter- and intrapersonal factors, and financial and health care system considerations that head and neck cancer physicians weigh during this decision-making process. Data Sources PubMed. Review Methods Selected literature on head and neck surgical oncologists' decision making in end-of-life care and palliative therapy was reviewed and analyzed thematically. Conclusions Physicians taking into account patients' clinical trajectories often overestimate the negative impact of head and neck cancer symptoms on their quality of life, suggesting that patients' expectations of quality of life should be discussed early, before communication barriers arise. How head and neck clinicians perceive and are influenced by patients' desired degree of autonomy, which varies greatly depending on the severity of illness, is still unclear. Patients' financial and insurance status affects decision making about hospice care. Finally, physician demographics (eg, age, subspecialization, practice setting), emotions, and philosophical background may exert unconscious biases that have not been fully determined for head and neck surgical oncologists. Implications for Practice A more comprehensive understanding of the head and neck surgical oncologist's approach toward considering a transition to therapy with palliative intent may help guide advancements in this complex counseling process, leading to improvements in patient care, quality of life, and outcomes.
KW - end of life
KW - head and neck cancer
KW - palliative
KW - patient safety and quality of life
KW - physician decision making
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U2 - 10.1177/0194599816667712
DO - 10.1177/0194599816667712
M3 - Article
C2 - 27625024
AN - SCOPUS:85008485797
SN - 0194-5998
VL - 156
SP - 46
EP - 51
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
IS - 1
ER -