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. 2018 Dec 1;124(23):4556-4566.
doi: 10.1002/cncr.31709. Epub 2018 Oct 5.

What do transplant physicians think about palliative care? A national survey study

Areej El-Jawahri  1   2 , Thomas W LeBlanc  3 , Linda J Burns  4 , Ellen Denzen  4 , Christa Meyer  4 , Lih-Wen Mau  4 , Eric J Roeland  5 , William A Wood  6 , Effie Petersdorf  7
Affiliations

What do transplant physicians think about palliative care? A national survey study

Areej El-Jawahri et al. Cancer. .

Abstract

Background: Despite its established benefits, palliative care (PC) is rarely utilized for hematopoietic stem cell transplant (HSCT) patients. We sought to examine transplant physicians' perceptions of PC.

Methods: We conducted a cross-sectional survey of transplant physicians recruited from the American-Society-for-Blood-and-Marrow-Transplantation. Using a 28-item questionnaire adapted from prior studies, we examined physicians' access to PC services, and perceptions of PC. We computed a composite score of physicians' attitudes about PC (mean = 16.9, SD = 3.37) and explored predictors of attitudes using a linear mixed model.

Results: 277/1005 (28%) of eligible physicians completed the questionnaire. The majority (76%) stated that they trust PC clinicians to care for their patients, but 40% felt that PC clinicians do not have enough understanding to counsel HSCT patients about their treatments. Most endorsed that when patients hear the term PC, they feel scared (82%) and anxious (76%). Nearly half (46%) reported that the service name 'palliative care' is a barrier to utilization. Female sex (β = 0.85, P = .024), having <10 years of clinical practice (β = 1.39, P = .004), and perceived quality of PC services (β = 0.60, P < .001) were all associated with a more positive attitude towards PC. Physicians with a higher sense of ownership over their patients' PC issues (β = -0.36, P < .001) were more likely to have a negative attitude towards PC.

Conclusions: The majority of transplant physicians trust PC, but have substantial concerns about PC clinicians' knowledge about HSCT and patients' perception of the term 'palliative care'. Interventions are needed to promote collaboration, improve perceptions, and enhance integration of PC for HSCT recipients.

Keywords: attitudes about palliative care; barriers to palliative care; hematopoietic stem cell transplantation (HSCT); perceptions of palliative care; unmet palliative care needs..

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Conflict of interest statement

Conflict of Interest Disclosures: None

Figures

Figure 1
Figure 1. Physicians’ attitudes about palliative care
PC = palliative care.
Figure 2
Figure 2. Physicians’ perceptions of patients’ attitudes towards palliative care
A) physicians’ perceptions of patients’ emotional reaction towards palliative care; B) physicians’ perceptions of patients’ attitudes towards palliative care
Figure 2
Figure 2. Physicians’ perceptions of patients’ attitudes towards palliative care
A) physicians’ perceptions of patients’ emotional reaction towards palliative care; B) physicians’ perceptions of patients’ attitudes towards palliative care
Figure 3
Figure 3. Physicians’ perspectives on the terms palliative care and supportive care
A) Physicians’ perspectives on the term ‘palliative care’: EOL = end of life; B) Physicians’ perspectives on the term ‘supportive care’: EOL = end of life
Figure 3
Figure 3. Physicians’ perspectives on the terms palliative care and supportive care
A) Physicians’ perspectives on the term ‘palliative care’: EOL = end of life; B) Physicians’ perspectives on the term ‘supportive care’: EOL = end of life
Figure 4
Figure 4
Physicians’ perceptions of unmet palliative care needs in HSCT
See this image and copyright information in PMC

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