Andrea Cuviello1, Jessica C Raisanen2, Pamela K Donohue3, Lori Wiener4, Renee D Boss5. 1. Johns Hopkins School of Medicine, Baltimore, Maryland, USA; National Institutes of Health, Bethesda, Maryland, USA. Electronic address: ajcuviello@gmail.com. 2. Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA. 3. Johns Hopkins School of Medicine, Baltimore, Maryland, USA. 4. National Institutes of Health, Bethesda, Maryland, USA. 5. Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA.
Abstract
CONTEXT: Although palliative care (PC) continues to be integrated into pediatric oncological care, only a minority of patients with cancer receive a formal PC consult. OBJECTIVES: We sought to describe oncologists' current understanding of PC and how primary PC is provided for children with cancer. METHODS: This mixed-methods study explored pediatric oncology providers' definitions of PC and self-reported PC practices through semistructured audiotaped interviews. Conventional content analysis was applied to interview transcripts. RESULTS: Seventy-seven participants with diverse training backgrounds (30 attending physicians, 21 nurses, 18 fellows, five nurse practitioners, and two child life specialists) completed an interview. Approximately 75% provided a modern definition of PC (e.g., not limited to end-of-life care); all participants acknowledged primary PC skills as part of their daily clinical activities. However, participants expressed wide variation in the comfort and time spent performing primary PC tasks (i.e., symptom management, addressing mental health and psychosocial needs) and over half reported that patients' PC needs are not adequately met. In addition, some reported confusion about the benefits of PC consultation, despite acknowledging that PC needs to be better integrated into the care of pediatric oncology patients. CONCLUSION: Our findings demonstrate that although most pediatric oncologists accept a modern definition of PC in theory, how to integrate PC into pediatric oncology practice is less understood. Formalized training and standardization of practice surrounding identification of PC needs in patients who may require secondary or tertiary PC services may help to overcome current barriers for PC integration in pediatric oncology.
CONTEXT: Although palliative care (PC) continues to be integrated into pediatric oncological care, only a minority of patients with cancer receive a formal PC consult. OBJECTIVES: We sought to describe oncologists' current understanding of PC and how primary PC is provided for children with cancer. METHODS: This mixed-methods study explored pediatric oncology providers' definitions of PC and self-reported PC practices through semistructured audiotaped interviews. Conventional content analysis was applied to interview transcripts. RESULTS: Seventy-seven participants with diverse training backgrounds (30 attending physicians, 21 nurses, 18 fellows, five nurse practitioners, and two child life specialists) completed an interview. Approximately 75% provided a modern definition of PC (e.g., not limited to end-of-life care); all participants acknowledged primary PC skills as part of their daily clinical activities. However, participants expressed wide variation in the comfort and time spent performing primary PC tasks (i.e., symptom management, addressing mental health and psychosocial needs) and over half reported that patients' PC needs are not adequately met. In addition, some reported confusion about the benefits of PC consultation, despite acknowledging that PC needs to be better integrated into the care of pediatric oncology patients. CONCLUSION: Our findings demonstrate that although most pediatric oncologists accept a modern definition of PC in theory, how to integrate PC into pediatric oncology practice is less understood. Formalized training and standardization of practice surrounding identification of PC needs in patients who may require secondary or tertiary PC services may help to overcome current barriers for PC integration in pediatric oncology.
Authors: Lori Wiener; Anne E Kazak; Robert B Noll; Andrea Farkas Patenaude; Mary Jo Kupst Journal: Pediatr Blood Cancer Date: 2015-09-23 Impact factor: 3.167
Authors: Barbara J Cashavelly; Karen Donelan; Kathryn D Binda; Johanna R Mailhot; Katherine A Clair-Hayes; Peter Maramaldi Journal: Oncologist Date: 2008-05
Authors: Todd Dalberg; Elizabeth Jacob-Files; Patricia A Carney; Jeffrey Meyrowitz; Erik K Fromme; Gregory Thomas Journal: Pediatr Blood Cancer Date: 2013-07-09 Impact factor: 3.167
Authors: Saskia Jünger; Andrea E Vedder; Sigurd Milde; Thomas Fischbach; Boris Zernikow; Lukas Radbruch Journal: BMC Palliat Care Date: 2010-06-04 Impact factor: 3.234
Authors: Enikő Földesi; Szilvia Zörgő; Judit Nyirő; György Péter; Gábor Ottóffy; Peter Hauser; Katalin Hegedűs Journal: Children (Basel) Date: 2022-05-02
Authors: Andrea Cuviello; Jessica C Raisanen; Pamela K Donohue; Lori Wiener; Renee D Boss Journal: J Pain Symptom Manage Date: 2020-07-22 Impact factor: 5.576