Department of Oncology and Metabolism, 7315University of Sheffield, United Kingdom.
Palliative Care Institute, 4591University of Liverpool, United Kingdom.
J Palliat Care. 2021 Apr;36(2):121-129. doi: 10.1177/0825859720957817. Epub 2020 Sep 15.
To report on direct experiences from advanced head and neck cancer patients, family carers and healthcare professionals, and the barriers to integrating specialist palliative care.
Using a naturalistic, interpretative approach, within Northwest England, a purposive sample of adult head and neck cancer patients was selected. Their family carers were invited to participate. Healthcare professionals (representing head and neck surgery and specialist nursing; oncology; specialist palliative care; general practice and community nursing) were recruited. All participants underwent face-to-face or telephone interviews. A thematic approach, using a modified version of Colazzi's framework, was used to analyze the data.
Seventeen interviews were conducted (9 patients, 4 joint with family carers and 8 healthcare professionals). Two main barriers were identified by healthcare professionals: "lack of consensus about timing of Specialist Palliative Care engagement" and "high stake decisions with uncertainty about treatment outcome." The main barrier identified by patients and family carers was "lack of preparedness when transitioning from curable to incurable disease." There were 2 overlapping themes from both groups: "uncertainty about meeting psychological needs" and "misconceptions of palliative care."
Head and neck cancer has a less predictable disease trajectory, where complex decisions are made and treatment outcomes are less certain. Specific focus is needed to define the optimal way to initiate Specialist Palliative Care referrals which may differ from those used for the wider cancer population. Clearer ways to effectively communicate goals of care are required potentially involving collaboration between Specialist Palliative Care and the wider head and neck cancer team.
报告高级头颈部癌症患者、家庭护理者和医疗保健专业人员的直接经验，以及整合专科姑息治疗的障碍。
在英格兰西北部，采用自然主义、解释性方法，选择了成年头颈部癌症患者的目的性样本。邀请他们的家属照顾者参加。招募了医疗保健专业人员（代表头颈部外科和专科护理；肿瘤学；专科姑息治疗；普通科和社区护理）。所有参与者都接受了面对面或电话采访。采用 Colazzi 框架的修改版本，使用主题方法分析数据。
共进行了 17 次访谈（9 名患者，4 名与家属照顾者联合，8 名医疗保健专业人员）。医疗保健专业人员确定了两个主要障碍：“缺乏对专科姑息治疗参与时机的共识”和“高风险决策，对治疗结果不确定”。患者和家属护理者确定的主要障碍是“从可治愈疾病向不可治愈疾病过渡时缺乏准备”。两组都有两个重叠的主题：“对满足心理需求的不确定性”和“对姑息治疗的误解”。
头颈部癌症的疾病轨迹较不可预测，需要做出复杂的决策，治疗结果也较不确定。需要特别关注确定启动专科姑息治疗转诊的最佳方式，这可能与更广泛的癌症人群使用的方式不同。需要更明确的方法来有效地传达护理目标，可能需要专科姑息治疗和更广泛的头颈部癌症团队之间的合作。
