Casey M Hay1, Carolyn Lefkowits, Megan Crowley-Matoka, Marie A Bakitas, Leslie H Clark, Linda R Duska, Renata R Urban, Lee-May Chen, Stephanie L Creasy, Yael Schenker. 1. *Division of Gynecologic Oncology, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA; †Division of Gynecologic Oncology and ‡Palliative Care, Department of Medicine, University of Colorado Denver, Denver, CO; §Medical Education/Medical Humanities and Bioethics/Anthropology, Northwestern University, Chicago, IL; ∥Department of Medicine, School of Nursing, University of Alabama at Birmingham, Birmingham, AL; ¶Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC; #Division of Gynecologic Oncology, University of Virginia School of Medicine, Charlottesville, VA; **Division of Gynecologic Oncology, University of Washington, Seattle, WA; ††University of California Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; and ‡‡Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health; and §§Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA.
Abstract
OBJECTIVE: Early specialty palliative care is underused for patients with advanced gynecologic malignancies. We sought to understand how gynecologic oncologists' views influence outpatient specialty palliative care referral to help inform strategies for improvement. METHODS/MATERIALS: We conducted a qualitative interview study at 6 National Cancer Institute-designated cancer centers with well-established outpatient palliative care services. Between September 2015 and March 2016, 34 gynecologic oncologists participated in semistructured telephone interviews focused on attitudes, experiences, and preferences related to outpatient specialty palliative care. A multidisciplinary team analyzed transcripts using constant comparative methods to inductively develop a coding framework. Through an iterative, analytic process, codes were classified, grouped, and refined into themes. RESULTS: Mean (SD) participant age was 47 (10) years. Mean (SD) interview length was 25 (7) minutes. Three main themes emerged regarding how gynecologic oncologists view outpatient specialty palliative care: (1) long-term relationships with patients is a unique and defining aspect of gynecologic oncology that influences referral, (2) gynecologic oncologists value palliative care clinicians' communication skills and third-party perspective to increase prognostic awareness and help negotiate differences between patient preferences and physician recommendation, and (3) gynecologic oncologists prefer specialty palliative care services embedded within gynecologic oncology clinics. CONCLUSIONS: Gynecologic oncologists value longitudinal relationships with patients and use specialty palliative care to negotiate conflict surrounding prognostic awareness or the treatment plan. Embedding specialty palliative care within gynecologic oncology clinics may promote communication between clinicians and facilitate gynecologic oncologist involvement throughout the illness course.
OBJECTIVE: Early specialty palliative care is underused for patients with advanced gynecologic malignancies. We sought to understand how gynecologic oncologists' views influence outpatient specialty palliative care referral to help inform strategies for improvement. METHODS/MATERIALS: We conducted a qualitative interview study at 6 National Cancer Institute-designated cancer centers with well-established outpatient palliative care services. Between September 2015 and March 2016, 34 gynecologic oncologists participated in semistructured telephone interviews focused on attitudes, experiences, and preferences related to outpatient specialty palliative care. A multidisciplinary team analyzed transcripts using constant comparative methods to inductively develop a coding framework. Through an iterative, analytic process, codes were classified, grouped, and refined into themes. RESULTS: Mean (SD) participant age was 47 (10) years. Mean (SD) interview length was 25 (7) minutes. Three main themes emerged regarding how gynecologic oncologists view outpatient specialty palliative care: (1) long-term relationships with patients is a unique and defining aspect of gynecologic oncology that influences referral, (2) gynecologic oncologists value palliative care clinicians' communication skills and third-party perspective to increase prognostic awareness and help negotiate differences between patient preferences and physician recommendation, and (3) gynecologic oncologists prefer specialty palliative care services embedded within gynecologic oncology clinics. CONCLUSIONS: Gynecologic oncologists value longitudinal relationships with patients and use specialty palliative care to negotiate conflict surrounding prognostic awareness or the treatment plan. Embedding specialty palliative care within gynecologic oncology clinics may promote communication between clinicians and facilitate gynecologic oncologist involvement throughout the illness course.
Authors: David Hui; Ahmed Elsayem; Maxine De la Cruz; Ann Berger; Donna S Zhukovsky; Shana Palla; Avery Evans; Nada Fadul; J Lynn Palmer; Eduardo Bruera Journal: JAMA Date: 2010-03-17 Impact factor: 56.272
Authors: Micael Lopez-Acevedo; William J Lowery; Ashlei W Lowery; Paula S Lee; Laura J Havrilesky Journal: Gynecol Oncol Date: 2013-06-14 Impact factor: 5.482
Authors: Yael Schenker; Megan Crowley-Matoka; Daniel Dohan; Michael W Rabow; Cardinale B Smith; Douglas B White; Edward Chu; Greer A Tiver; Sara Einhorn; Robert M Arnold Journal: J Oncol Pract Date: 2013-12-03 Impact factor: 3.840
Authors: Thomas J Smith; Sarah Temin; Erin R Alesi; Amy P Abernethy; Tracy A Balboni; Ethan M Basch; Betty R Ferrell; Matt Loscalzo; Diane E Meier; Judith A Paice; Jeffrey M Peppercorn; Mark Somerfield; Ellen Stovall; Jamie H Von Roenn Journal: J Clin Oncol Date: 2012-02-06 Impact factor: 44.544
Authors: Eric Nolley; Jessica Fleck; Dio Kavalieratos; Mary Amanda Dew; Daniel Dilling; Rebecca Colman; Maria M Crespo; Hiliary Goldberg; Steven Hays; Ramsey Hachem; Erika Lease; James Lee; John Reynolds; Matthew Morrell; Yael Schenker Journal: J Palliat Med Date: 2020-01-02 Impact factor: 2.947
Authors: Casey M Hay; Carolyn Lefkowits; Megan Crowley-Matoka; Marie A Bakitas; Leslie H Clark; Linda R Duska; Renata R Urban; Stephanie L Creasy; Yael Schenker Journal: J Oncol Pract Date: 2017-08-01 Impact factor: 3.714