Kruser Tim J, Kruser Jacqueline M, Gross Jeffrey P, Moran Margaret, Kaiser Karen, Szmuilowicz Eytan, Kircher Sheetal M
Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Ann Palliat Med. 2020 Sep;9(5):2800-2808. doi: 10.21037/apm-20-270. Epub 2020 Aug 7.
Early palliative care referral for patients with advanced cancer has demonstrable benefits but is underutilized. We sought to characterize medical oncologists' perceptions about palliative care referral in their clinical practices.
We conducted 4 focus groups with a national sample of medical oncologists to elicit perspectives about the optimal timing of and barriers to palliative care referral for patients with cancer. We used qualitative content analysis to uncover themes related to early integration of palliative care into standard oncologic practice.
Study participants readily acknowledged the evidence supporting early palliative care referral. However, medical oncologists identified patient-centered and physician-centered barriers to widespread adoption of early palliative care. Patient-centered barriers included patients' and families' perceptions or misperceptions of the role of palliative care. Additionally, physicians themselves described acting as a barrier to palliative care referral because they were concerned that palliative care physicians may interfere with the plan of care, or offer options that were not endorsed by the medical oncologist. Medical oncologists depicted themselves having authority over the timing of palliative care referral, and as granting limited autonomy to other clinical team members in counseling patients about advanced care planning.
Medical oncologists are hesitant to adopt the practice of early palliative care referral because they are concerned that other physicians may disrupt a patient's treatment plan. Physician-centered barriers may delay integration of palliative care, and future efforts to promote a collaborative approach to advanced care planning may improve patient-centered outcomes through access to early palliative care.
对晚期癌症患者进行早期姑息治疗转诊已证明有诸多益处，但目前未得到充分利用。我们试图了解肿瘤内科医生在其临床实践中对姑息治疗转诊的看法。
我们对全国范围内的肿瘤内科医生样本进行了4次焦点小组讨论，以了解他们对癌症患者姑息治疗转诊的最佳时机和障碍的看法。我们采用定性内容分析法来揭示与将姑息治疗早期纳入标准肿瘤学实践相关的主题。
研究参与者欣然承认支持早期姑息治疗转诊的证据。然而，肿瘤内科医生确定了以患者为中心和以医生为中心的障碍，这些障碍阻碍了早期姑息治疗的广泛采用。以患者为中心的障碍包括患者及其家属对姑息治疗作用的看法或误解。此外，医生自己也表示是姑息治疗转诊的障碍，因为他们担心姑息治疗医生可能会干扰护理计划，或者提供肿瘤内科医生不认可的选择。肿瘤内科医生认为自己有权决定姑息治疗转诊的时机，并且在就晚期护理计划向患者提供咨询时，给予其他临床团队成员的自主权有限。
肿瘤内科医生对采用早期姑息治疗转诊的做法犹豫不决，因为他们担心其他医生可能会打乱患者的治疗计划。以医生为中心的障碍可能会延迟姑息治疗的整合，未来促进晚期护理计划采用协作方法的努力可能会通过提供早期姑息治疗来改善以患者为中心的结果。
