Pifer Phillip M, Farrugia Mark K, Mattes Malcolm D
1 Department of Radiation Oncology, West Virginia University, Morgantown, WV, USA.
Am J Hosp Palliat Care. 2018 Oct;35(10):1287-1291. doi: 10.1177/1049909118763592. Epub 2018 Mar 7.
Early palliative/supportive care (PSC) consultation and advance care planning (ACP) improve outcomes for patients with incurable cancer. However, PSC is underutilized in the United States.
To examine philosophical differences among PSC, radiation oncology (RO), and medical oncology (MO) physicians in order to understand barriers to early PSC referral.
An electronic survey collected views of a nationwide cohort of health-care professionals regarding ACP and end-of-life care. Setting/Participants/Measurements: A subgroup analysis compared the responses from all 51 PSC, 178 RO, and 81 MO physician participants (12% response rate), using Pearson χ and Mann-Whitney U tests for categorical and ordinal data, respectively.
More statistically significant differences were observed between RO-PSC (12 questions) and MO-PSC (12 questions) than RO-MO (4 questions). Both RO and MO were more likely than PSC physicians to believe doctors adequately care for emotional ( P < .001) and physical ( P < .001) needs of patients with an incurable illness. Both RO and MO were also less likely to believe that PSC physicians were helpful at addressing these needs ( P = .002 and <.001, respectively) or that patients' awareness of their life expectancy leads to better medical ( P = .007 and .002, respectively) and personal ( P = .001 for each) decisions. Palliative/supportive care physicians felt that doctors are generally less successful at explaining/clarifying advanced life-sustaining treatments than RO ( P < .001) or MO ( P = .004). MO favored later initiation of ACP than either RO ( P = .006) or PSC physicians ( P = .004).
Differences in perception of appropriate end-of-life care exist between oncologists and PSC physicians, suggesting a need for improved education and communication between these groups.
早期姑息/支持性护理（PSC）咨询和预立医疗计划（ACP）可改善无法治愈癌症患者的治疗结果。然而，在美国，PSC的利用率较低。
研究PSC、放射肿瘤学（RO）和医学肿瘤学（MO）医生之间的理念差异，以了解早期PSC转诊的障碍。
一项电子调查收集了全国范围内一组医疗保健专业人员对ACP和临终护理的看法。设置/参与者/测量：亚组分析比较了所有51名PSC、178名RO和81名MO医生参与者的回答（回复率为12%），分别使用Pearson χ检验和Mann-Whitney U检验处理分类数据和有序数据。
与RO-MO（4个问题）相比，RO-PSC（12个问题）和MO-PSC（12个问题）之间观察到的统计学显著差异更多。RO和MO医生比PSC医生更有可能认为医生充分照顾了无法治愈疾病患者的情感（P <.001）和身体（P <.001）需求。RO和MO也不太可能认为PSC医生在满足这些需求方面有帮助（分别为P =.002和<.001），或者患者对预期寿命的了解会导致更好的医疗（分别为P =.007和.002）和个人（均为P =.001）决策。姑息/支持性护理医生认为，与RO（P <.001）或MO（P =.004）相比，医生在解释/阐明高级生命维持治疗方面通常不太成功。MO比RO（P =.006）或PSC医生（P =.004）更倾向于较晚开始ACP。
肿瘤学家和PSC医生在对适当临终护理的认知上存在差异，这表明需要改善这些群体之间的教育和沟通。
