Skip to main content
×
Home

Oncologists' perspectives on concurrent palliative care in a National Cancer Institute-designated comprehensive cancer center

  • Marie Bakitas (a1) (a2), Kathleen Doyle Lyons (a3), Mark T. Hegel (a3) and Tim Ahles (a4)
Abstract
AbstractObjective:

The purpose of this study was to understand oncology clinicians' perspectives about the care of advanced cancer patients following the completion of the ENABLE II (Educate, Nurture, Advise, Before Life Ends) randomized clinical trial (RCT) of a concurrent oncology palliative care model.

Method:

This was a qualitative interview study of 35 oncology clinicians about their approach to patients with advanced cancer and the effect of the ENABLE II RCT.

Results:

Oncologists believed that integrating palliative care at the time of an advanced cancer diagnosis enhanced patient care and complemented their practice. Self-assessment of their practice with advanced cancer patients comprised four themes: (1) treating the whole patient, (2) focusing on quality versus quantity of life, (3) “some patients just want to fight,” and (4) helping with transitions; timing is everything. Five themes comprised oncologists' views on the complementary role of palliative care: (1) “refer early and often,” (2) referral challenges: “Palliative” equals “hospice”; “Heme patients are different,” (3) palliative care as consultants or co-managers, (4) palliative care “shares the load,” and (5) ENABLE II facilitated palliative care integration.

Significance of results:

Oncologists described the RCT as holistic and complementary, and as a significant factor in adopting concurrent care as a standard of care.

Copyright
Corresponding author
Address correspondence and reprint requests to: Marie Bakitas, Section of Palliative Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756. E-mail: marie.bakitas@hitchcock.org
References
Hide All
Back A.L., Arnold R.M., Tulsky J.A., et al. (2003). Teaching communication skills to medical oncology fellows. Journal of Clinical Oncology, 21, 2433.
Baile W., Buckman R., Lenzi R., et al. (2000). SPIKES-A six-step protocol for delivering bad news: Application to the patient with cancer. Oncologist, 5, 302.
Bakitas M., Ahles T., Skalla K., et al. (2008). Proxy perspectives regarding end-of-life care for persons with cancer. Cancer, 112, 18541861.
Bakitas M., Lyons K., Dixon J., et al. (2006). Palliative care program effectiveness research: Developing rigor in sampling design, conduct and reporting. Journal of Pain and Symptom Management, 31, 270284.
Bakitas M., Lyons K., Hegel M., et al. (2009a). Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The Project ENABLE II randomized controlled trial. Journal of the American Medical Assocation, 302, 741749.
Bakitas M., Lyons K., Hegel M., et al. (2009b). Project ENABLE II randomized controlled trial to improve palliative care for rural patients with advanced cancer: Baseline findings, methodological challenges, and solutions. Palliative & Supportive Care, 7, 7586.
Bakitas M., Stevens M., Ahles T., et al. (2004). Project ENABLE: A palliative care demonstration project for advanced cancer patients in three settings. Journal of Palliative Medicine, 7, 363372.
Buss M.K., Lessen D.S., Sullivan A.M., et al. (2007). A study of oncology fellows' training in end-of-life care. Journal of Supportive Oncology, 5, 237242.
Center to Advance Palliative Care. (2011). 2011 Public Opinion Research on Palliative Care: A Report Based on Research by Public Opinion Strategies. New York: Center to Advance Palliative Care and American Cancer Society Action Network.
Cherny N.I. & Catane R. (2003). Attitutudes of medical oncologists toward palliative care for patients with advanced and incurable cancer: Report on a survey by the European Society of Medical Oncology Taskforce on Palliative and Supportive Care. Cancer, 98, 25022510.
Earle C.C., Landrum M.B., Souza J.M., et al. (2008). Aggressiveness of cancer care near the end of life: is it a quality-of-care issue? Journal of Clinical Oncology, 26, 38603866.
El-jawahri A., Greer J.A. & Temel J.S. (2011). Does palliative care improve outcomes for patients with incurable illness? A review of the evidence. The Journal of Supportive Oncology, 9, 8794.
Engelhardt J.B., McClive-Reed K.P., Toseland R.W., et al. (2006). Effects of a program for coordinated care of advanced illness on patients, surrogates, and healthcare costs: a randomized trial. American Journal of Managed Care, 12, 93100.
Fadul N., Elsayem A., Palmer J.L., et al. (2009). Supportive versus palliative care: What's in a name? Cancer, 115, 20132021.
Fallowfield L., Jenkins V., Farewell V., et al. (2002). Efficacy of a cancer research UK communication skills training model for oncologists: A randomised controlled trial. Lancet, 359, 650.
Fallowfield L., Jenkins V., Farewell V., et al. (2003). Enduring impact of communication skills training: Results of a 12-month follow up. British Journal of Cancer, 89, 1445.
Ferrell B.R. (2005). Late referrals to palliative care. Journal of Clinical Oncology, 23, 908909.
Graneheim U.H. & Lundman B. (2004). Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 105112.
Grunfeld E., Whelan T.J., Zitzelsberger L., et al. (2000). Cancer care workers in Ontario: Prevalence of burnout, job stress and job satisfaction. Canadian Medical Association Journal, 163, 166.
Jackson V.A., Mack J., Matsuyama R., et al. (2008). A Qualitative Study of Oncologists' Approaches to End-of-Life Care. Journal of Palliative Medicine, 11, 893906.
Kash K.M., Holland J.C., Breitbart W., et al. (2000). Stress and burnout in oncology. Oncology, 14, 1621.
Lamont E. & Christakis N.A. (2002). Physician factors in the timing of cancer patient referral to hospice palliative care. Cancer, 94, 27332737.
Larochelle M.R., Rodriguez K.L., Arnold R.M., et al. (2009). Hospital staff attributions of the causes of physician variation in end-of-life treatment intensity. Palliative Medicine, 23, 460470.
Lofmark R., Nilstun T. & Bolmsjo I.A. (2007). From cure to palliation: Concept, decision and acceptance. Journal of Medical Ethics, 33, 685688.
Mahon M.M. & McAuley W.J. (2010). Oncology nurses' personal understandings about palliative care. Oncology Nursing Forum, 37, E141–150.
McGrath P.D. & Holewa H.A. (2007). Description of an Australian model for end-of-life care in patients with hematologic malignancies. Oncology Nursing Forum, 34, 7985.
Morita T., Akechi T., Ikenaga M., et al. (2005). Late referrals to specialized palliative care service in Japan. Journal of Clinical Oncology, 23, 107114.
Polit D. & Beck C. (2005). Understanding qualitative research design. In Essentials of Nursing Research Method, Appraisal, and Utilization. New York: Lippincott.
Rodriguez K.L., Gambino F.J., Butow P., et al. (2007). Pushing up daisies: Implicit and explicit language in oncologist–patient communication about death. Supportive Care in Cancer, 15, 153161.
Sandelowski M. (1996). Using qualitative methods in intervention studies. Research in Nursing and Health, 19, 359364.
Sandelowski M. (2000). Whatever happened to qualitative description. Research in Nursing and Health, 23, 334340.
Smith T.J., Temin S., Alesi E.R., et al. (2012). American Society of Clinical Oncology provisional clinical opinion: The integration of palliative care into standard oncology care. Journal of Clinical Oncology, 30, 880887.
Temel J.S., Greer J.A., Muzikansky A., et al. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine, 363, 733742.
von Gunten C.F. (2008). Oncologists and end-of-life care. Journal of Palliative Medicine, 11, 813.
Wetle T., Shield R., Teno J., et al. (2005). Family perspectives on end-of-life care experiences in nursing homes. Gerontologist, 45, 642650.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Palliative & Supportive Care
  • ISSN: 1478-9515
  • EISSN: 1478-9523
  • URL: /core/journals/palliative-and-supportive-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Full text views

Total number of HTML views: 3
Total number of PDF views: 53 *
Loading metrics...

Abstract views

Total abstract views: 312 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 19th November 2017. This data will be updated every 24 hours.