Hui David, Park Minjeong, Liu Diane, Reddy Akhila, Dalal Shalini, Bruera Eduardo
Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Oncologist. 2015 Nov;20(11):1326-32. doi: 10.1634/theoncologist.2015-0240. Epub 2015 Sep 28.
Palliative care (PC) referrals are often delayed for patients with hematologic malignancies. We examined the differences in attitudes and beliefs toward PC referral between hematologic and solid tumor specialists and how their perception changed with use of the service name "supportive care" (SC).
We randomly surveyed 120 hematologic and 120 solid tumor oncology specialists at our tertiary care cancer center to examine their attitudes and beliefs toward PC and SC referral.
Of the 240 specialists, 182 (76%) responded. Compared with solid tumor specialists, hematologic specialists were less likely to report that they would refer symptomatic patients with newly diagnosed cancer to PC (solid tumor, 43% vs. hematology, 21%; p = .002). A significantly greater proportion of specialists expressed that they would refer a patient with newly diagnosed cancer to SC than PC (solid tumor specialists: SC, 81% vs. PC, 43%; p < .001; hematology specialists: SC, 66% vs. PC, 21%; p < .001). The specialists perceived that PC was more likely than SC to be a barrier for referral (PC, 36% vs. SC, 3%; p < .001), to be synonymous with hospice (PC, 53% vs. SC, 6%; p < .001), to decrease hope (PC, 58% vs. SC, 8%; p < .001), and to be less appropriate for treatment of chemotherapy side effects (PC, 64% vs. SC, 19%; p < .001). On multivariate analysis, female clinicians (odds ratio [OR], 4.5; 95% confidence interval [CI], 1.3-15.2; p = .02) and the perception that PC is a barrier for referral (OR, 3.0; 95% CI, 1.2-7.6; p = .02) were associated with PC referral if the service name "SC" was used.
Hematologic specialists were less likely to refer patients early in the disease trajectory and were conducive to referral with the service name SC instead of PC.
The present survey of oncology specialists found that hematologic specialists were less likely than solid tumor specialists to report that they would refer symptomatic patients with newly diagnosed cancer to palliative care. However, both groups were significantly more willing to refer patients early in the disease trajectory if the service name "supportive care" were used instead of "palliative care." These findings suggest that rebranding might help to overcome the stigma associated with palliative care and improve patient access to palliative care services.
血液系统恶性肿瘤患者的姑息治疗（PC）转诊常常延迟。我们研究了血液科和实体瘤专科医生对PC转诊的态度和信念差异，以及他们对“支持性护理”（SC）这一服务名称的使用如何改变其认知。
我们在三级医疗癌症中心对120名血液科和120名实体瘤肿瘤专科医生进行了随机调查，以研究他们对PC和SC转诊的态度和信念。
240名专科医生中，182名（76%）做出了回应。与实体瘤专科医生相比，血液科专科医生报告称他们会将新诊断出癌症的有症状患者转诊至PC的可能性较小（实体瘤专科医生为43%，血液科专科医生为21%；p = 0.002）。与PC相比，有显著更多比例的专科医生表示他们会将新诊断出癌症的患者转诊至SC（实体瘤专科医生：SC为81%，PC为43%；p < 0.001；血液科专科医生：SC为66%，PC为21%；p < 0.001）。专科医生认为PC比SC更有可能成为转诊的障碍（PC为36%，SC为3%；p < 0.001），是临终关怀的同义词（PC为53%，SC为6%；p < 0.001），会降低希望（PC为58%，SC为8%；p < 0.001），且不太适合治疗化疗副作用（PC为64%，SC为19%；p < 0.001）。多因素分析显示，如果使用“SC”这一服务名称，女性临床医生（比值比[OR]，4.5；95%置信区间[CI]，1.3 - 15.2；p = 0.02）以及认为PC是转诊障碍的认知（OR，3.0；95% CI，1.2 - 7.6；p = 0.02）与PC转诊相关。
血液科专科医生在疾病进程早期转诊患者的可能性较小，使用“SC”而非“PC”这一服务名称有助于转诊。
本次对肿瘤专科医生的调查发现，血液科专科医生比实体瘤专科医生报告称他们会将新诊断出癌症的有症状患者转诊至姑息治疗的可能性更小。然而，如果使用“支持性护理”而非“姑息治疗”这一服务名称，两组医生都明显更愿意在疾病进程早期转诊患者。这些发现表明，重新命名可能有助于克服与姑息治疗相关的污名，并改善患者获得姑息治疗服务的机会。
