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. 2023 Jan;19(3):245-257.
doi: 10.2217/fon-2022-0958. Epub 2023 Mar 28.

Relationships among clinicians are crucial to successful palliative care integration: a qualitative study in lung cancer

Donald R Sullivan  1   2   3 , Kelly C Vranas  1   2   4   5 , Molly Delorit  2 , Sara E Golden  2 , Christopher G Slatore  1   2   3   4 , Linda Ganzini  2   6 , Lissi Hansen  3   7
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Relationships among clinicians are crucial to successful palliative care integration: a qualitative study in lung cancer

Donald R Sullivan et al. Future Oncol. 2023 Jan.

Abstract

Aims: Palliative care integration improves quality of life among patients with lung cancer and their families. Despite these benefits, significant barriers persist and patients do not receive timely integration. This study sought to identify facilitators of and barriers to integration in lung cancer care. Materials & methods: Semistructured qualitative interviews were conducted with palliative care and lung cancer clinicians and analyzed using traditional content analysis. 23 clinicians were interviewed from geographically dispersed hospitals within a national healthcare system. Results: Palliative care integration improved over time, enhanced by several facilitators stratified at four levels (patient/clinician/hospital/organization). Most important among these was multidisciplinary care delivered in outpatient settings, fostering trust and relationships among clinicians which were pivotal to successful integration. Workforce shortages and limited use of primary palliative care among lung cancer clinicians need to be addressed for continued growth in the field. Conclusion: Relationships among clinicians are crucial to successful palliative care integration in lung cancer care.

Keywords: health policy; health services; hospice; lung neoplasms; quality care; quality of life; veterans.

Plain language summary

Palliative care is a form of supportive care for patients with a serious illness that improves quality of life among patients with lung cancer and their families. Unfortunately, many patients do not receive this care until they are near the end of life. This study sought to explore clinicians' perspectives regarding ways to enhance the use of palliative care among patients with lung cancer. Using interviews of clinicians from geographically dispersed hospitals within a national healthcare system, the authors explored reasons and potential solutions to improve palliative care delivery. One of the most important factors in enhancing palliative care use was fostering trust and relationships among palliative care and lung cancer clinicians. Workforce shortages also need to be addressed for continued growth in the field of palliative care. Relationships among clinicians are crucial to successful palliative care integration in lung cancer care.

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Figures

Figure 1.
Figure 1.. Facilitators and barriers to palliative care integration based on patient, clinician, hospital and organization levels.
Clinicians described facilitators and barriers to palliative care use and integration at various level. Multidisciplinary, team-based palliative care models, usually delivered in outpatient settings, was a critical facilitator across multiple levels as perceived by palliative and non-palliative care lung cancer clinicians. Leveraging facilitators and addressing barriers across the healthcare system will be essential for successful palliative care implementaton in lung cancer programs. *See Table 2 for clinician quotes.
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