Sabih Abdul Hamid, Laube Robyn, Strasser Simone I, Lim Lynn, Cigolini Maria, Liu Ken
AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Department of Gastroenterology, Macquarie University Hospital, Macquarie Park, New South Wales, Australia.
BMJ Support Palliat Care. 2021 Mar 18. doi: 10.1136/bmjspcare-2020-002807.
Palliative care (PC) service involvement for hepatocellular carcinoma (HCC) patients is suboptimal and little is known about the underlying reasons for this. We aimed to study clinicians' experience and attitudes towards PC in HCC.
A nationwide survey was conducted of consultants/trainees recruited from the Gastroenterological Society of Australia membership directory. Clinician demographics, experience and attitudes towards PC use for HCC patients were collected.
There were 160 participants. Most attended weekly multidisciplinary team meetings (MDTM, 60%) and had no formal PC training (71%). MDTM with PC attendance was reported by 12%. Rates of PC referral increased incrementally from BCLC 0/A to D patients but were not universal even in advanced (46%) or terminal (87%) stages. Most acknowledged PC patient discussions occurred too late (61%). Those with prior PC training were more likely to refer BCLC 0/A and B patients for early PC. Referral rates for outpatient PC were higher in respondents who attended MDTM with PC present across all BCLC stages. PC service was rated good/very good by 70%/81% for outpatients/inpatients. Barriers to PC referral included clinician-perceived negative patient associations with PC (83%), clinician-perceived patient/caregiver lack of acceptance (81%/77%) and insufficient time (70%).
PC referral for HCC patients is not universal and occurs late even in late-stage disease. Prior PC training and/or PC presence at MDTM positively influences referral practices. Barriers to PC referral are not related to quality of PC services but rather to clinician-perceived patients' negative reactions to or lack of acceptance of PC.
姑息治疗（PC）服务在肝细胞癌（HCC）患者中的参与度欠佳，且对此背后的原因知之甚少。我们旨在研究临床医生对HCC患者姑息治疗的经验和态度。
对从澳大利亚胃肠病学会会员名录中招募的顾问医生/实习医生进行了一项全国性调查。收集了临床医生的人口统计学资料、经验以及对HCC患者使用姑息治疗的态度。
共有160名参与者。大多数人每周参加多学科团队会议（MDTM，60%），且没有接受过正规的姑息治疗培训（71%）。有12%的人报告称多学科团队会议有姑息治疗人员参加。从巴塞罗那临床肝癌（BCLC）0/A期到D期患者，姑息治疗转诊率逐渐上升，但即使在晚期（46%）或终末期（87%）阶段也并非普遍现象。大多数人承认姑息治疗患者讨论发生得太晚（61%）。那些接受过姑息治疗培训的人更有可能将BCLC 0/A期和B期患者转诊接受早期姑息治疗。在所有BCLC阶段，参加有多学科团队会议且有姑息治疗人员在场的受访者中，门诊姑息治疗转诊率更高。门诊/住院患者对姑息治疗服务的评价为良好/非常好的分别占70%/81%。姑息治疗转诊的障碍包括临床医生认为患者对姑息治疗有负面联想（83%）、临床医生认为患者/护理人员缺乏接受度（81%/77%）以及时间不足（70%）。
HCC患者的姑息治疗转诊并不普遍，即使在疾病晚期也发生得较晚。先前的姑息治疗培训和/或多学科团队会议中有姑息治疗人员参与对转诊实践有积极影响。姑息治疗转诊的障碍与姑息治疗服务质量无关，而是与临床医生认为患者对姑息治疗有负面反应或缺乏接受度有关。
