Skip to main content
SpringerLink
Log in

Oncologist Experience Implementing Goals of Care Discussions in Everyday Ambulatory Oncology Practice: Implications for Education

  • Published:
Journal of Cancer Education Aims and scope Submit manuscript

Abstract

Despite evidence that Goals of Care (GOC) discussions should occur early in the disease trajectory, the majority occur close to end of life. In a pilot, oncologists routinely initiated GOC discussions with all patients in their everyday ambulatory practice. Following the pilot, 9 of 12 eligible oncologists participated in semi-structured interviews about their experiences. Analysis resulted in the identification of seven principles of good GOC discussions embedded in the oncologists’ interviews, four barriers to engaging in GOC discussions and foundational education needs. Participants believed that the appropriate trigger for a GOC discussion is a diagnosis of advanced cancer, not simply a diagnosis of cancer, and supported the importance of selective and strategic targeting of GOC discussions. The findings have informed the development of an education-based model for culture change within a province-wide cancer care system.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Barakat A, Barnes S A, Cassanova M A, Stone M J, Shuey K M, & Miller A M (2013) Advance care planning knowledge and documentation in a hospitalized cancer population. Proceedings (Baylor University: Medical Centre), (26)4: 368–72

  2. Barnes KA, Barlow CA, Harrington J, Ornadel K, Tookman A, King M, Jones L (2011) Advance care planning discussions in advanced cancer: analysis of dialogues between patients and care planning mediators. Palliat Support Care 9:73–79. doi:10.1017/S1478951510000568

    Article  PubMed  Google Scholar 

  3. Dow LA, Matsuyama RK, Ramakrishnan V, Kuhn L, Lamont EB, Lyckholm L, Smith TJ (2010) Paradoxes in advance care planning: the complex relationship of oncology patients, their physicians, and advance medical directives. J Clin Oncol 28:299–304. doi:10.1200/JCO.2009.24.6397

    Article  CAS  PubMed  Google Scholar 

  4. El-Sahwi KS, Illuzzi J, Varughese J, Carusillo N, Ratner ES, Silasi DA, Azodi M, Schwartz PE, Rutherford TJ, Santin AD (2012) A survey of gynecologic oncologists regarding the end-of-life discussion: a pilot study. Gynecol Oncol 124:471–473. doi:10.1016/j.ygyno.2011.09.029

    Article  PubMed  Google Scholar 

  5. Mack JW, Cronin A, Taback N, Huskamp HA, Keating NL, Malin JL, Earle CC, Weeks JC (2012) End-of-life care discussions among patients with advanced cancer: a cohort study. Ann Intern Med 156:204–210. doi:10.7326/0003-4819-156-3-201202070-00008

    Article  PubMed  PubMed Central  Google Scholar 

  6. Lopez-Acevedo M, Havrilesky LJ, Broadwater G, Kamal AH, Abernathy AP, Berchuck A, Alvarez-Secord A, Tulsky JA, Valea F, Lee PS (2013) Timing of end-of-life care discussion with performance on end-of-life quality indicators in ovarian cancer. Gynecol Oncol 130:156–161. doi:10.1016/j.ygyno.2013.04.01031

    Article  PubMed  Google Scholar 

  7. Advance Care Planning in Canada National Framework Project Task Group (2012) Advance care planning in Canada: National Framework. Canadian Hospice Palliative Care Association. http://www.advancecareplanning.ca/media/40158/acp%20framework%202012%20eng.pdf Accessed 5 June 2014

  8. Harle I, Johnston J, Mackay J, Mayer C, Russell S, Zwaal C (2008) Advance Care Planning with Cancer Patients: Guideline Recommendations Evidence-Based Series (#19-1. Program in Evidence-Based Care). Cancer Care Ontario. https://www.cancercare.on.ca/common/pages/UserFile.aspx?serverId=6&path=/File%20Database/CCO%20Files/PEBC/pebc19-1f.pdf. Accessed 5 June 2014

  9. Peppercorn JM, Smith TJ, Helft PR, DeBono DJ, Berry SR, Wollins DS, Hayes DM, Von Roenn JH, Schnipper LE (2011) American Society of Clinical Oncology Statement: toward individualised care for patients with advanced cancer. J Clin Oncol 29:755–760. doi:10.1200/JCO.2010.33.174415

    Article  PubMed  Google Scholar 

  10. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:722–742

    Article  Google Scholar 

  11. Keam B, Yun YH, Heo DS, Park BW, Cho CH, Kim S, Lee DH, Chun M (2013) he attitudes of Korean cancer patients, family caregivers, oncologists, and members of the general public toward advance directives. Support Care Cancer 21:1437–1444. doi:10.1007/s00520-012-1689-z 29

    Article  PubMed  Google Scholar 

  12. Huskamp HA, Keating NL, Malin JL, Zaslavsky AM, Weeks JC, Earle CC, Teno JM, Virnig BA, Kahn KL, He Y, Ayanian JZ (2009) Discussions with physicians about hospice among patients with metastatic lung cancer. JAMA Int Med 169:954–962. doi:10.1001/archinternmed.2009.127

    Article  Google Scholar 

  13. Parker SM, Clayton JM, Hancock K, Walder S, Butow PN, Carrick S, Currow D, Tattersall MHN (2007) A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preference for the content, style and timing of information. J Pain Symptom Manag 34:81–93. doi:10.1016/j.jpainsymman.2006.09.035

    Article  Google Scholar 

  14. Granek L, Krzyzanowska MK, Tozer R, Mazzotta P (2013) Oncologists’ strategies and barriers to effective communication about the end-of-life. J Oncol Pract 9:129–135. doi:10.1200/JOP.2012.000800

    Article  Google Scholar 

  15. Hummers-Pradier E, Scheidt-Nave C, Martin H, Heinemann S, Kochen MM, Himmel W (2008) Simply no time? Barriers to GP’s participation in primary health care research. Fam Pract 25:105–112. doi:10.1093/fampra/cmn015

    Article  PubMed  Google Scholar 

  16. Glaser BG, Strauss AL (1967) The discovery of grounded theory. Aldine, Chicago

    Google Scholar 

  17. Fried TR, Bradley EH, Towle VR, Allore H (2002) Understanding the treatment preferences of seriously ill patients. N Engl J Med 346:1061–1066. doi:10.1056/NEJMsa012528

    Article  PubMed  Google Scholar 

  18. Bernacki R E, & Block S D (2014) Communication about serious illness care goals: a review and synthesis of best practices. JAMA Internal Medicine, published online October 20, 2014. doi:10.1001/jamainternmed.2014.5271

  19. Anselm AH, Palda V, Guest CB, McLean RF, Vachon MLS, Kelner M, Lam-McCulloch J (2005) Barriers to communication regarding end-of-life care: perspectives of care providers. J Crit Care 20:214–223. doi:10.1016/j.jcrc.2005.05.012

    Article  PubMed  Google Scholar 

  20. Sudore RL, Knight SJ, McMahan RD, Feuz M, Farrell D, Miao Y, Barnes DE (2014) A novel website to prepare diverse older adults for decision making and advance care planning: a pilot study. J Pain Symptom Manag 47:674–686. doi:10.1016/j.jpainsymman.2013.05.023

    Article  Google Scholar 

  21. Wright AA, Zhang B, Keating NL, Weeks JC, Prigerson HG (2014) Associations between palliative chemotherapy and adult cancer patients’ end-of-life care and place of death: prospective cohort study. BMJ 348:g1219. doi:10.1136/bmj.g1219

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lennes IT, Temel JS, Hoedt C, Meilleur A, Lamont EB (2013) Predictors of newly diagnosed cancer patients’ understanding of the goals of their care at initiation of chemotherapy. Cancer 119:691–699. doi:10.1002/cncr.27787

    Article  PubMed  Google Scholar 

  23. Weeks JC, Catalano PJ, Cronin A, Finkelman MD, Mack JW, Keating NL, Schrag D (2012) Patients’ expectations about effects of chemotherapy for advanced cancer. N Engl J Med 367:1616–1625. doi:10.1056/NEJMoa1204410

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Mack JW, Smith TJ (2012) Reasons why physicians do not have discussions about poor prognosis, why it matters, and what can be improved. J Clin Oncol 30:2715–2717. doi:10.1200/JCO.2012.42.4564

    Article  PubMed  Google Scholar 

  25. Billings JA, Bernacki R (2014) Strategic targeting of advance care planning interventions: the Goldilocks phenomenon. JAMA Int Med 174:620–624. doi:10.1001/jamainternmed.2013.14384

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Nursing, University of British Columbia, ART 132, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada

    Carole A. Robinson

  2. Medical Lead, Pain and Symptom Management Palliative Care Program, BC Cancer Agency Sindi Ahluwalia Hawkins Centre for the Southern Interior, 399 Royal Avenue, Kelowna, BC, V1Y 5L3, Canada

    Gillian Fyles

  3. Radiation Therapy Program, BC Cancer Agency Vancouver Cancer Centre, 600 West 10th Avenue, Vancouver, BC, V6S 1R6, Canada

    Michael McKenzie

Authors
  1. Carole A. Robinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gillian Fyles
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael McKenzie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carole A. Robinson.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Robinson, C.A., Fyles, G. & McKenzie, M. Oncologist Experience Implementing Goals of Care Discussions in Everyday Ambulatory Oncology Practice: Implications for Education. J Canc Educ 32, 301–307 (2017). https://doi.org/10.1007/s13187-015-0915-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13187-015-0915-z

Keywords

Search

Navigation