Perceptions of palliative care among hematologic malignancy specialists: A mixed-methods study.

Authors

Thomas LeBlanc

Thomas William LeBlanc

Division of Hematologic Malignancies and Cell Therapy, Duke University School of Medicine, Durham, NC

Thomas William LeBlanc, Jonathan David O'Donnell, Megan Crowley-Makota, Daniel Paul Dohan, Michael W. Rabow, Cardinale B. Smith, Douglas B White, Greer A Tiver, Robert Arnold, Yael Schenker

Organizations

Division of Hematologic Malignancies and Cell Therapy, Duke University School of Medicine, Durham, NC, Duke University School of Medicine, Durham, NC, Feinberg School of Medicine, Northwestern University, Chicago, IL, University of California, San Francisco, San Francisco, CA, Icahn School of Medicine at Mount Sinai, New York, NY, Clinical Research, Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA, University of Pittsburgh Medical Center, Pittsburgh, PA

Research Funding

No funding sources reported

Background: Patients with hematologic malignancies have unmet palliative care needs but are less likely to receive specialist palliative care services than patients with solid tumors. This difference is poorly understood. Methods: Multisite, mixed-methods study to understand and contrast perceptions of palliative care among hematologic oncologists and solid tumor oncologists. Between February and October 2012, oncologists at 3 academic medical centers with well-established palliative care services completed surveys assessing referral practices and in-depth, semi-structured interviews about their views of palliative care. We compared referral patterns using standard statistical methods. We then analyzed qualitative interview data using constant comparative methods to explore reasons for observed differences. Results: Among 66 interviewees, 23 oncologists cared exclusively for patients with hematologic malignancies, and 43 treated only patients with solid tumors. Seven of 23 hematologic oncologists (30%) reported never referring a patient to palliative care; all solid tumor oncologists had previously referred (p<0.001). In qualitative analyses, most hematologic oncologists viewed palliative care as end-of-life care, while most solid tumor oncologists viewed palliative care as a subspecialty that could assist with complex cases and/or offload burden in a busy clinic. Solid tumor oncologists emphasized practical barriers to palliative care referral, such as appointment availability and reimbursement issues. Hematologic oncologists emphasized philosophical concerns about palliative care referrals, including different treatment goals, responsiveness to chemotherapy, and a preference to control palliative aspects of patient care. Conclusions: Most hematologic oncologists view palliative care as end-of-life care, while solid tumor oncologists more often view palliative care as a subspecialty for co-managing complex patients. Efforts to integrate palliative care into hematologic malignancy practices will require solutions that address unique barriers to palliative care referral experienced by hematologic oncologists.

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Abstract Details

Meeting

2014 Palliative and Supportive Care in Oncology Symposium

Session Type

Poster Session

Session Title

General Poster Session B: <span>Early Integration of Palliative Care in Cancer Care, Patient-Reported Outcomes, and Psycho-Oncology</span>

Track

Early Integration of Palliative Care in Cancer Care,Patient-Reported Outcomes: Mechanisms of Symptoms and Treatment Toxicities,Psycho-oncology,End-of-Life Care,Survivorship

Sub Track

Early Integration of Palliative Care in Cancer Care

Citation

J Clin Oncol 32, 2014 (suppl 31; abstr 9)

DOI

10.1200/jco.2014.32.31_suppl.9

Abstract #

9

Poster Bd #

A11

Abstract Disclosures