Palliative and Supportive Care

Original Articles

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

Marie Bakitasa1a2 c1, Kathleen Doyle Lyonsa3, Mark T. Hegela3 and Tim Ahlesa4

a1 Department of Anesthesiology, Section of Palliative Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire

a2 Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire

a3 Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire

a4 Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York

Abstract

Objective: 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.

(Received May 09 2012)

(Accepted June 10 2012)

Keywords

  • Oncologist;
  • Oncology nurse practitioner;
  • Concurrent oncology palliative care;
  • Qualitative research;
  • Healthcare delivery

Correspondence

c1 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