Department of Behavioral Science, University of Kentucky College of Medicine, 760 Press Avenue, 467 Healthy Kentucky Research Building, Lexington, KY, USA.
Center for Health, Engagement, and Transformation, University of Kentucky, Lexington, KY, USA.
Support Care Cancer. 2024 Sep 2;32(9):627. doi: 10.1007/s00520-024-08816-5.
Clinical guidelines recommend early palliative care for patients with advanced lung cancer. In rural and underserved community oncology practices with limited resources, both primary palliative care from an oncologist and specialty palliative care are needed to address patients' palliative care needs. The aim of this study is to describe community oncology clinicians' primary palliative care practices and perspectives on integrating specialty palliative care into routine advanced lung cancer treatment in rural and underserved communities.
Participants were clinicians recruited from 15 predominantly rural community oncology practices in Kentucky. Participants completed a one-time survey regarding their primary palliative care practices and knowledge, barriers, and facilitators to integrating specialty palliative care into advanced-stage lung cancer treatment.
Forty-seven clinicians (30% oncologists) participated. The majority (72.3%) of clinicians worked in a rural county. Over 70% reported routinely asking patients about symptom and physical function concerns, whereas less than half reported routinely asking about key prognostic concerns. Roughly 30% held at least one palliative care misconception (e.g., palliative care is for only those who are stopping cancer treatment). Clinician-reported barriers to specialty palliative care referrals included fear a referral would send the wrong message to patients (77%) and concern about burdening patients with appointments (53%). Notably, the most common clinician-reported facilitator was a patient asking for a referral (93.6%).
Educational programs and outreach efforts are needed to inform community oncology clinicians about palliative care, empower patients to request referrals, and facilitate patients' palliative care needs assessment, documentation, and standardized referral templates.
临床指南建议为晚期肺癌患者提供早期姑息治疗。在资源有限的农村和服务不足社区肿瘤学实践中，需要初级姑息治疗和专业姑息治疗来满足患者的姑息治疗需求。本研究旨在描述社区肿瘤学临床医生在农村和服务不足社区中为晚期肺癌患者提供初级姑息治疗的实践情况，并探讨将专业姑息治疗纳入常规治疗的看法。
参与者是从肯塔基州的 15 家主要农村社区肿瘤学实践中招募的临床医生。参与者完成了一次关于其初级姑息治疗实践以及将专业姑息治疗纳入晚期肺癌治疗的障碍和促进因素的调查。
47 名临床医生（30%为肿瘤学家）参与了调查。大多数（72.3%）临床医生在农村县工作。超过 70%的临床医生报告说经常询问患者的症状和身体功能问题，但不到一半的人报告经常询问关键预后问题。大约 30%的人持有至少一个姑息治疗误解（例如，姑息治疗仅适用于那些停止癌症治疗的人）。临床医生报告的专业姑息治疗转介障碍包括担心转介会向患者发出错误信息（77%）和担心增加患者预约负担（53%）。值得注意的是，最常见的临床医生报告的促进因素是患者要求转介（93.6%）。
需要开展教育计划和外展活动，向社区肿瘤学临床医生提供姑息治疗信息，赋予患者请求转介的权力，并促进患者的姑息治疗需求评估、记录和标准化转介模板的使用。
