Instituto de Oncología de Rosario, Rosario, Santa Fe, Argentina. E-mail:
Unidad de Cuidados Paliativos Hospital Dr. E. Tornú, Buenos Aires, Argentina.
Medicina (B Aires). 2023;83(1):10-18.
Local evidence suggests insufficient access to palliative care (PC) for advanced cancer patients. The objective was to investigate the attitudes and beliefs of Argentinian medical oncologists regarding PC referral of their patients.
All medical oncologists listed in the main national Clinical Oncology Associations (N = 831) were invited to participate in a telephone survey.
Fifty nine percent (N = 489) completed the survey. Most reported being informed about the scopes of PC (83%) and having accessible PC service/specialists (71%). However, 53% did not work collaboratively, and 55% exceptionally or never referred their patients. Oncologists who usually referred their patients did so mainly due to uncontrolled pain (67%) or absence of curative treatment (48%). Only 19% supported early-referral criteria. Those who exceptionally referred their patients argued that PC was not meaningful/beneficial/a priority (78%) or that they preferred to handle the patient's problems by themselves (55%). End-of-life care (33%) and improvement in quality of life (32%) were stated as primary benefits of PC for cancer patients. Addressing psychological aspects was considered the least important item (2%). Having an accessible PC service (P = 0.002) and being well informed about PC (P = 0.008) were associated with frequent referral. Having =10 years or >30 years from graduation were associated with exceptional or no referral (P = 0.012 and 0.001, respectively).
Oncologists report awareness of the potential advantages of PC and have accessible PC services, but rarely refer patients. They mainly use late-referral criteria. Younger and older age are negatively associated with referral. More research is needed to improve the referral rate and timing of cancer patients to PC.
当地证据表明，晚期癌症患者获得姑息治疗（PC）的机会不足。本研究旨在调查阿根廷肿瘤内科医生对其患者 PC 转诊的态度和信念。
邀请主要国家临床肿瘤学协会（N=831）列出的所有肿瘤内科医生参加电话调查。
59%（N=489）完成了调查。大多数报告说他们了解 PC 的范围（83%）并且可以获得 PC 服务/专家（71%）。然而，53%的医生没有协作，55%的医生偶尔或从不转诊其患者。通常转诊患者的肿瘤医生主要是因为患者有无法控制的疼痛（67%）或没有治愈性治疗（48%）。只有 19%的医生支持早期转诊标准。那些偶尔转诊患者的医生认为 PC 没有意义/有益/不是优先事项（78%），或者他们更喜欢自己处理患者的问题（55%）。临终关怀（33%）和提高生活质量（32%）被认为是 PC 对癌症患者的主要益处。解决心理方面的问题被认为是最不重要的项目（2%）。拥有可及的 PC 服务（P=0.002）和对 PC 有充分了解（P=0.008）与频繁转诊相关。毕业 10 年或 30 年以上的医生更倾向于偶尔或不转诊（P=0.012 和 0.001）。
肿瘤医生报告说他们意识到 PC 的潜在优势，并拥有可及的 PC 服务，但很少转诊患者。他们主要使用晚期转诊标准。年轻和年长的医生与转诊呈负相关。需要进一步研究以提高癌症患者对 PC 的转诊率和转诊时机。
