Anna Sorensen1, Kirsten Wentlandt1,2, Lisa W Le3, Nadia Swami1, Breffni Hannon1,4, Gary Rodin1,5,6, Monika K Krzyzanowska4,7, Camilla Zimmermann8,9,10. 1. Department of Supportive Care, Princess Margaret Cancer Centre, 610 University Ave., 16-712, Toronto, Ontario, M5G 2M9, Canada. 2. Department of Family and Community Medicine, University of Toronto, Toronto, Canada. 3. Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada. 4. Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada. 5. Princess Margaret Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada. 6. Department of Psychiatry, University of Toronto, Toronto, Canada. 7. Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada. 8. Department of Supportive Care, Princess Margaret Cancer Centre, 610 University Ave., 16-712, Toronto, Ontario, M5G 2M9, Canada. camilla.zimmermann@uhn.ca. 9. Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada. camilla.zimmermann@uhn.ca. 10. Princess Margaret Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada. camilla.zimmermann@uhn.ca.
Abstract
PURPOSE: To describe the practices and opinions of specialized palliative care (SPC) physicians regarding early palliative care for patients with cancer, determine characteristics associated with receiving early referrals; and solicit opinions regarding renaming the specialty "supportive care." METHODS: The survey was distributed by mail and e-mail to physicians who had previously self-identified as providing palliative care. SPC physicians were defined as receiving palliative care referrals from other physicians and not providing palliative care only for their own patients. RESULTS: The response rate was 71% (531/746), of whom 257 (48.4%) practiced SPC. Of these SPC physicians, 84% provided mainly cancer care; > 90% supported early palliative care referral in oncology and had referral criteria facilitating this, but only 20% received early referrals (> 6-month prognosis). There was ambivalence regarding caring for patients with full resuscitation status and responsibility for managing cancer treatment-related complications. SPC physicians receiving early referrals were more likely to be female (p = 0.02) and have a postgraduate degree (p = 0.02), and less likely to provide mainly cancer care (p = 0.03) and to agree that patients should stop chemotherapy before referral (p = 0.009). Although 60% agreed that patients perceive the term "palliative care" negatively and 39% believed a name change to supportive care would encourage early referral, only 21% supported renaming the specialty. CONCLUSIONS: Although most SPC physicians supported early palliative care in oncology, the timing of referrals was often late, and was associated with characteristics of SPC physicians. Few SPC physicians supported renaming palliative care.
PURPOSE: To describe the practices and opinions of specialized palliative care (SPC) physicians regarding early palliative care for patients with cancer, determine characteristics associated with receiving early referrals; and solicit opinions regarding renaming the specialty "supportive care." METHODS: The survey was distributed by mail and e-mail to physicians who had previously self-identified as providing palliative care. SPC physicians were defined as receiving palliative care referrals from other physicians and not providing palliative care only for their own patients. RESULTS: The response rate was 71% (531/746), of whom 257 (48.4%) practiced SPC. Of these SPC physicians, 84% provided mainly cancer care; > 90% supported early palliative care referral in oncology and had referral criteria facilitating this, but only 20% received early referrals (> 6-month prognosis). There was ambivalence regarding caring for patients with full resuscitation status and responsibility for managing cancer treatment-related complications. SPC physicians receiving early referrals were more likely to be female (p = 0.02) and have a postgraduate degree (p = 0.02), and less likely to provide mainly cancer care (p = 0.03) and to agree that patients should stop chemotherapy before referral (p = 0.009). Although 60% agreed that patients perceive the term "palliative care" negatively and 39% believed a name change to supportive care would encourage early referral, only 21% supported renaming the specialty. CONCLUSIONS: Although most SPC physicians supported early palliative care in oncology, the timing of referrals was often late, and was associated with characteristics of SPC physicians. Few SPC physicians supported renaming palliative care.
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Authors: David Hausner; Colombe Tricou; Jean Mathews; Deepa Wadhwa; Ashley Pope; Nadia Swami; Breffni Hannon; Gary Rodin; Monika K Krzyzanowska; Lisa W Le; Camilla Zimmermann Journal: Oncologist Date: 2021-01-02