Massachusetts General Hospital, Boston, Massachusetts, United States.
Harvard Medical School, Boston, Massachusetts, United States.
Cancer. 2018 Dec 1;124(23):4556-4566. doi: 10.1002/cncr.31709. Epub 2018 Oct 5.
Despite its established benefits, palliative care (PC) is rarely utilized for hematopoietic stem cell transplant (HSCT) patients. We sought to examine transplant physicians' perceptions of PC.
We conducted a cross-sectional survey of transplant physicians recruited from the American-Society-for-Blood-and-Marrow-Transplantation. Using a 28-item questionnaire adapted from prior studies, we examined physicians' access to PC services, and perceptions of PC. We computed a composite score of physicians' attitudes about PC (mean = 16.9, SD = 3.37) and explored predictors of attitudes using a linear mixed model.
277/1005 (28%) of eligible physicians completed the questionnaire. The majority (76%) stated that they trust PC clinicians to care for their patients, but 40% felt that PC clinicians do not have enough understanding to counsel HSCT patients about their treatments. Most endorsed that when patients hear the term PC, they feel scared (82%) and anxious (76%). Nearly half (46%) reported that the service name 'palliative care' is a barrier to utilization. Female sex (β = 0.85, P = .024), having <10 years of clinical practice (β = 1.39, P = .004), and perceived quality of PC services (β = 0.60, P < .001) were all associated with a more positive attitude towards PC. Physicians with a higher sense of ownership over their patients' PC issues (β = -0.36, P < .001) were more likely to have a negative attitude towards PC.
The majority of transplant physicians trust PC, but have substantial concerns about PC clinicians' knowledge about HSCT and patients' perception of the term 'palliative care'. Interventions are needed to promote collaboration, improve perceptions, and enhance integration of PC for HSCT recipients.
尽管姑息治疗（PC）已被证实具有益处，但在造血干细胞移植（HSCT）患者中却很少使用。我们试图研究移植医生对 PC 的看法。
我们对从美国血液与骨髓移植协会招募的移植医生进行了横断面调查。我们使用了一项改编自先前研究的 28 项问卷，调查了医生获得 PC 服务的情况以及对 PC 的看法。我们计算了医生对 PC 态度的综合评分（平均值= 16.9，SD = 3.37），并使用线性混合模型探讨了态度的预测因素。
277/1005（28%）名符合条件的医生完成了问卷。大多数（76%）医生表示信任 PC 临床医生照顾他们的患者，但 40%的医生认为 PC 临床医生对 HSCT 患者的治疗指导缺乏足够的了解。大多数医生认为，当患者听到 PC 一词时，他们会感到恐惧（82%）和焦虑（76%）。近一半（46%）的医生报告称，服务名称“姑息治疗”是阻碍其使用的一个因素。女性（β= 0.85，P =.024）、临床实践经验不足 10 年（β= 1.39，P =.004）和感知 PC 服务质量（β= 0.60，P <.001）与对 PC 的更积极态度相关。对患者 PC 问题拥有更高所有权感的医生（β= -0.36，P <.001）更有可能对 PC 持消极态度。
大多数移植医生信任 PC，但对 PC 临床医生对 HSCT 的了解以及患者对“姑息治疗”一词的看法存在重大担忧。需要采取干预措施促进合作，改善认知并增强 HSCT 患者的 PC 整合。
