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Practices and opinions of specialized palliative care physicians regarding early palliative care in oncology

Supportive Care in Cancer volume 28, pages 877–885 (2020)Cite this article

Abstract

Purpose

To describe the practices and opinions of specialized palliative care (SPC) physicians regarding early palliative care for patients with cancer, determine characteristics associated with receiving early referrals; and solicit opinions regarding renaming the specialty “supportive care.”

Methods

The survey was distributed by mail and e-mail to physicians who had previously self-identified as providing palliative care. SPC physicians were defined as receiving palliative care referrals from other physicians and not providing palliative care only for their own patients.

Results

The response rate was 71% (531/746), of whom 257 (48.4%) practiced SPC. Of these SPC physicians, 84% provided mainly cancer care; > 90% supported early palliative care referral in oncology and had referral criteria facilitating this, but only 20% received early referrals (> 6-month prognosis). There was ambivalence regarding caring for patients with full resuscitation status and responsibility for managing cancer treatment-related complications. SPC physicians receiving early referrals were more likely to be female (p = 0.02) and have a postgraduate degree (p = 0.02), and less likely to provide mainly cancer care (p = 0.03) and to agree that patients should stop chemotherapy before referral (p = 0.009). Although 60% agreed that patients perceive the term “palliative care” negatively and 39% believed a name change to supportive care would encourage early referral, only 21% supported renaming the specialty.

Conclusions

Although most SPC physicians supported early palliative care in oncology, the timing of referrals was often late, and was associated with characteristics of SPC physicians. Few SPC physicians supported renaming palliative care.

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Acknowledgments

We are grateful to Michelle Veer and the Canadian Society of Palliative Care Physicians for their assistance in the distribution of our survey to palliative care providers across Canada and to Nanor Kevork, BSc, and Ashley Pope, BSc (Department of Supportive Care, University Health Network) for their support and assistance with survey development and data collection.

Funding

This research was funded by the Canadian Cancer Society (CCS, William E. Rawls prize and grant no. 700862; CZ), the Canadian Institutes of Health Research (grant no. 152996; CZ), and the Ontario Ministry of Health and Long Term Care. Dr. Zimmermann is supported by the Rose Family Chair in Palliative Medicine and Supportive Care, Department of Medicine, University of Toronto.

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Authors and Affiliations

  1. Department of Supportive Care, Princess Margaret Cancer Centre, 610 University Ave., 16-712, Toronto, Ontario, M5G 2M9, Canada

    Anna Sorensen, Kirsten Wentlandt, Nadia Swami, Breffni Hannon, Gary Rodin & Camilla Zimmermann

  2. Department of Family and Community Medicine, University of Toronto, Toronto, Canada

    Kirsten Wentlandt

  3. Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada

    Lisa W. Le

  4. Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada

    Breffni Hannon, Monika K. Krzyzanowska & Camilla Zimmermann

  5. Princess Margaret Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada

    Gary Rodin & Camilla Zimmermann

  6. Department of Psychiatry, University of Toronto, Toronto, Canada

    Gary Rodin

  7. Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada

    Monika K. Krzyzanowska

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  1. Anna Sorensen
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  2. Kirsten Wentlandt
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  3. Lisa W. Le
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  7. Monika K. Krzyzanowska
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  8. Camilla Zimmermann
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Corresponding author

Correspondence to Camilla Zimmermann.

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This study was reviewed and approved by the Research Ethics Board of the University Health Network.

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The authors declare they have no conflicts of interest and no relationships with the organizations that funded the research. The authors have full control of all primary data and agree to allow the journal to review data if requested.

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Sorensen, A., Wentlandt, K., Le, L.W. et al. Practices and opinions of specialized palliative care physicians regarding early palliative care in oncology. Support Care Cancer 28, 877–885 (2020). https://doi.org/10.1007/s00520-019-04876-0

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  • DOI: https://doi.org/10.1007/s00520-019-04876-0

Keywords

  • Cancer
  • Oncology
  • Palliative care
  • Referral
  • Survey