TY - JOUR
T1 - Impact of oncologists’ attitudes toward end-of-life care on patients’ access to palliative care
AU - Hui, David
AU - Cerana, Maria Agustina
AU - Park, Minjeong
AU - Hess, Kenneth
AU - Bruera, Eduardo
N1 - Publisher Copyright:
© AlphaMed Press 2016.
PY - 2016/9
Y1 - 2016/9
N2 - Background. It is unclear how oncologists’ attitudes toward end-of-life (EOL) care affect the delivery of care. The present study examined the association between oncologists’ EOL care attitudes and (a) timely specialist palliative care referral, (b) provision of supportive care, and (c) EOL cancer treatment decisions. Methods. We randomly surveyed 240 oncology specialists at our tertiary care cancer center to assess their attitudes toward EOL care usingascore derived from the Jackson etal. qualitative conceptual framework (0 5 uncomfortable and 85 highly comfortable with EOL care). We determined the association between this score and clinicians’ report of specialist palliative care referral, provision of supportive care, and EOL cancer treatment decisions. Results. Of the 182 respondents (response rate of 76%), the median composite EOL care score was 6 (interquartile range, 5-7). A higher EOL score was significantly associated with solid tumor oncology (median 7 vs. 6 for hematologic on- cology; p = .003), a greater willingness to refer patients with newly diagnosed cancer to specialist palliative care (median, 7vs.6;p=.01),greatercomfortwithsymptommanagement (median, 6 vs. 5; p = .01), and provision of counseling (median, 7 vs. 4; p < .001) but not with cancer treatment decisions. We observed a gradient effect, with higher scores associated with a greater proportion of patients referred to palliative care (score 0-4, 27%; 5, 31%; 6, 32%; 7, 35%; and 8, 45%; p 5.007). Conclusion. Greater comfort with EOL care was associated with higher rates of specialist palliative care referral and self- reported primary palliative care delivery. More support and education are needed for oncologists who are less comfortable with EOL care.
AB - Background. It is unclear how oncologists’ attitudes toward end-of-life (EOL) care affect the delivery of care. The present study examined the association between oncologists’ EOL care attitudes and (a) timely specialist palliative care referral, (b) provision of supportive care, and (c) EOL cancer treatment decisions. Methods. We randomly surveyed 240 oncology specialists at our tertiary care cancer center to assess their attitudes toward EOL care usingascore derived from the Jackson etal. qualitative conceptual framework (0 5 uncomfortable and 85 highly comfortable with EOL care). We determined the association between this score and clinicians’ report of specialist palliative care referral, provision of supportive care, and EOL cancer treatment decisions. Results. Of the 182 respondents (response rate of 76%), the median composite EOL care score was 6 (interquartile range, 5-7). A higher EOL score was significantly associated with solid tumor oncology (median 7 vs. 6 for hematologic on- cology; p = .003), a greater willingness to refer patients with newly diagnosed cancer to specialist palliative care (median, 7vs.6;p=.01),greatercomfortwithsymptommanagement (median, 6 vs. 5; p = .01), and provision of counseling (median, 7 vs. 4; p < .001) but not with cancer treatment decisions. We observed a gradient effect, with higher scores associated with a greater proportion of patients referred to palliative care (score 0-4, 27%; 5, 31%; 6, 32%; 7, 35%; and 8, 45%; p 5.007). Conclusion. Greater comfort with EOL care was associated with higher rates of specialist palliative care referral and self- reported primary palliative care delivery. More support and education are needed for oncologists who are less comfortable with EOL care.
KW - Access
KW - Attitude
KW - End-of-life care
KW - Neoplasms
KW - Palliative care
KW - Referral
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U2 - 10.1634/theoncologist.2016-0090
DO - 10.1634/theoncologist.2016-0090
M3 - Article
C2 - 27412394
AN - SCOPUS:84988035831
SN - 1083-7159
VL - 21
SP - 1149
EP - 1155
JO - Oncologist
JF - Oncologist
IS - 9
ER -