1 Department of Palliative Care, The Royal Melbourne Hospital , Parkville, Victoria, Australia .
J Palliat Med. 2014 May;17(5):553-8. doi: 10.1089/jpm.2013.0473. Epub 2014 Mar 3.
Lung cancer remains the leading cause of cancer death, and it is known many affected will have significant palliative care needs. Evidence suggests that early involvement of palliative care can translate into improvements in quality of care, quality of life, and survival. However, routine early integration is yet to be embraced as standard of care for the majority of patients, and it is unclear what lung cancer clinicians continue to perceive as the barriers to this model of care.
We performed a qualitative exploration of lung cancer clinicians' perceptions, focusing on current experiences of engaging with palliative care, perceptions of palliative care for patients with lung cancer, and views of barriers and benefits of referring to palliative care.
Focus group and targeted interviews were conducted with 28 clinicians, with four key emergent themes: 1) Competence/skill--with referrers needing to be confident in the quality and capability of palliative care provision; 2) Care Coordination--the need to ensure integrated care, with defined lines of responsibility and clear team communication; 3) Ease of referral--the need for ready access to a palliative care provider in the lung cancer clinic; and 4) Perceptions--concerns about loss of hope and fears of negative patient reaction.
Early and routine involvement of palliative care in patients with incurable lung cancer is acceptable to the majority of treating clinicians. To facilitate early integration of palliative care, palliative care providers need to become front-line team members who provide a high-quality service. Lung cancer clinicians need further education as to the role and benefits of early palliative care, and how best to introduce this.
肺癌仍然是癌症死亡的主要原因，众所周知，许多患者将有重大的姑息治疗需求。有证据表明，姑息治疗的早期介入可以转化为改善护理质量、生活质量和生存率。然而，常规的早期综合治疗尚未被大多数患者接受为标准治疗，目前尚不清楚肺癌临床医生仍然认为哪些因素是这种治疗模式的障碍。
我们对肺癌临床医生的看法进行了定性探讨，重点关注他们目前与姑息治疗的互动体验、对肺癌患者姑息治疗的看法，以及对转诊的障碍和益处的看法。
对 28 名临床医生进行了焦点小组和针对性访谈，得出了四个关键的主题：1）能力/技能-转诊者需要对姑息治疗的质量和能力有信心；2）护理协调-需要确保综合护理，明确责任界限和团队沟通；3）转诊的便利性-需要在肺癌诊所能够方便地获得姑息治疗提供者；4）认知-对失去希望的担忧和对患者负面反应的恐惧。
大多数治疗医生都接受在无法治愈的肺癌患者中早期和常规地介入姑息治疗。为了促进姑息治疗的早期整合，姑息治疗提供者需要成为一线团队成员，提供高质量的服务。肺癌临床医生需要进一步了解早期姑息治疗的作用和益处，以及如何最好地引入这种治疗。
