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Goals of care discussions: perceptions of radiation and medical oncologists

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Abstract

Background

Goals of care discussions (GOCD) are essential when counseling patients with cancer. Respective roles of radiation oncologists (RO) and medical oncologists (MO) in GOCD can be unclear. This study aims to clarify the dynamics and barriers to GOCD.

Methods

Five hundred and fifty-four ROs and 1604 MOs at NCI-designated comprehensive cancer centers were sent an anonymous electronic survey regarding demographics, opinions, training in GOCD, GOCD frequency, and three vignettes. Response formats were Yes/No, Likert-type, and free response. Chi-square and Wilcoxon rank-sum tests were performed. Likert-type scores were reported as median [interquartile range].

Results

There were 76 (13.7%) RO and 153 (9.5%) MO who completed surveys. Sixty-three percent of RO and 66% of MO reported GOCD with > 50% of patients (p = 0.90). GOCD were initiated for declining performance status (74%) and poor life expectancy (69%). More MO (42%) received formal GOCD training compared to RO (18%) (p < 0.01). MO were more comfortable conducting GOCD than RO (p < 0.01). RO-conducted GOCD were rated to be less important by MO compared to RO (p < 0.05). Thirty-six percent of MO reported being “not at all” or “somewhat” comfortable with RO-conducted GOCD. RO-initiated GOCD with new patients were rated less appropriate by RO compared to MO perceptions of RO-initiated GOCD (p < 0.01).

Conclusions

While MO and RO conduct GOCD with similar frequency, MO are more comfortable conducting GOCD and are more likely to have formal training. MO rate importance of RO involvement lower than RO. Further research is needed to understand interdisciplinary dynamics that may impact GOCD and subsequent patient care outcomes.

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Data availability

Data included in tables.

Code availability

REDCap used for survey distribution and data collection. Data analysis was completed with Stata 14 (Stata v14, StataCorp, College Station, TX).

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Funding

This project was funded in part by NIH CTSA UL1 TR000430.

Author information

Author notes

  1. Daniel W. Golden and Christina H. Son contributed equally to this project

Authors and Affiliations

  1. College of Medicine, University of Illinois at Chicago, Chicago, IL, USA

    Daniel Hong

  2. Beacon Health System, Elkhart, IN, USA

    Lauren C. Das

  3. Department of Medicine, The University of Chicago, Chicago, IL, USA

    Ellen Daily

  4. Department of Medicine, Section of Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL, USA

    Stacie K. Levine

  5. Department of Medicine, Section of Hematology-Oncology, The University of Chicago, Chicago, IL, USA

    Olwen M. Hahn

  6. Department of Radiation and Cellular Oncology, The University of Chicago, 5758 S. Maryland Ave MC 9006, Chicago, IL, 60637, USA

    Stanley L. Liauw, Daniel W. Golden & Christina H. Son

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  1. Daniel Hong
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Contributions

LCD, SKL, OMH, SLL, DWG, and CHS contributed to the conception and design of the study. LCD, ED, CHS, and DWG contributed to acquisition, analysis, and interpretation of data. DH, LCD, CHS, and DWG contributed to drafting and critical revisions of the article. DWG and CHS approved the final version of the article.

Corresponding author

Correspondence to Christina H. Son.

Ethics declarations

Ethics approval

This study was approved exempt by the University of Chicago Institutional Review Board.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

No identifying data or images from any individual participant was included in this article.

Conflicts of interest/Competing interests

The authors declare that they have no conflicts of interest.

Disclosure

Dr. Golden is manager of RadOncQuestions.com and HemOncReview.com. He reports grant funding from the National Institutes of Health, Radiation Oncology Institute, and Bucksbaum Institute for Clinical Excellence.

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Hong, D., Das, L.C., Daily, E. et al. Goals of care discussions: perceptions of radiation and medical oncologists. Support Care Cancer 29, 7279–7288 (2021). https://doi.org/10.1007/s00520-021-06258-x

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