Southern Adelaide Palliative Services, Daw Park, South Australia, Australia.
Palliat Med. 2009 Dec;23(8):698-707. doi: 10.1177/0269216309107004. Epub 2009 Oct 13.
Patients with advanced cancer often have complex care needs requiring collaboration between medical oncology and palliative care providers. Little is known about how effective and acceptable such collaboration is to medical oncologists. Attitudes of Australian medical oncologists toward collaboration with specialist palliative care services were investigated using a Web-based survey. Descriptive statistics and attitude indices were calculated and a thematic content analysis performed. One hundred and fifteen respondents (78 medical oncologists, 37 trainees) completed the survey (response rate 30.3%). Positive attitudes toward specialist palliative care involvement were expressed with most respondents preferring concurrent rather than sequential models of care (94.8%, n = 109). Reported barriers to collaboration included reluctance for referral by patients (minor 60.9%, n = 70; major 8.7%, n = 10) or families (minor 67%, n = 77; major 7%, n = 8), a lack of inpatient beds (minor 27%, n = 31; major 34.8%, n = 40) and inadequate resources for specialist palliative care to take some referrals (minor 30.4%, n = 35; major 30.4%, n = 35). There was no difference in attitude indices for those who had completed a palliative care rotation during their training (33%, n = 38) and those who had not. Suggestions for improvement in collaboration focused around four areas - improved resources, improved multidisciplinary links, mutual respect and understanding, and consistency in service provision. This study is the first to specifically investigate the views of Australian medical oncologists toward collaboration with specialist palliative care. While positive attitudes have been expressed, identified barriers to collaboration need attention.
晚期癌症患者通常有复杂的医疗需求，需要肿瘤内科医生和姑息治疗医生之间的合作。然而，对于肿瘤内科医生来说，这种合作的效果和可接受性如何，目前知之甚少。本研究通过在线调查，了解澳大利亚肿瘤内科医生对与专科姑息治疗服务合作的态度。计算了描述性统计数据和态度指数，并进行了主题内容分析。115 名受访者（78 名肿瘤内科医生，37 名培训生）完成了调查（应答率为 30.3%）。大多数受访者表示对专科姑息治疗的参与持积极态度，他们更喜欢同时进行而不是序贯治疗模式（94.8%，n=109）。报告的合作障碍包括患者（轻微障碍 60.9%，n=70；主要障碍 8.7%，n=10）或家属（轻微障碍 67%，n=77；主要障碍 7%，n=8）不愿意转介、缺乏住院病床（轻微障碍 27%，n=31；主要障碍 34.8%，n=40）以及专科姑息治疗资源不足无法接收部分转介（轻微障碍 30.4%，n=35；主要障碍 30.4%，n=35）。在培训期间完成姑息治疗轮转的医生（33%，n=38）和未完成的医生（67%，n=77）在态度指数上没有差异。改善合作的建议主要集中在四个方面——改善资源、改善多学科联系、相互尊重和理解以及服务提供的一致性。本研究首次专门调查了澳大利亚肿瘤内科医生对与专科姑息治疗合作的看法。尽管表达了积极的态度，但合作的障碍需要得到关注。
