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

Bakitas M, Lyons KD, Hegel MT, Ahles T.

Abstract

Purpose
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.

Methods
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.

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

Link to PubMed