‘Mystery shopper’ study reveals barriers to accessing palliative care

One-third of “mystery shopper” callers received limited or inaccurate information regarding palliative care services offered at NCI–designated cancer centers, according to study results presented at the Palliative Care in Oncology Symposium.

“Cancer centers have worked very hard to establish palliative and supportive care services to better meet the needs for the whole patient,” Kathryn Hutchins, a third-year medical student at Duke University, said in a press release. “It’s sobering to hear that such services are not readily accessible at many centers. However, it provides an opportunity for cancer centers to empower their frontline staff, as well as the oncology care team, through education and training so that the entire enterprise has a common understanding of palliative care and how to access it.”

All NCI–designated, comprehensive cancer centers report having a consultative palliative care service and six supportive care services. However, patients may face difficulties accessing these services if frontline office staff inaccurately understand what their cancer center offers.

Arif H. Kamal

Hutchins and colleagues used a “mystery shopper” study design, in which they simulated 160 calls made by a family member of a recently diagnosed patient with cancer. All callers inquired about a female patient aged 58 years who was recently diagnosed with inoperable liver cancer. They called all 40 NCI–designated cancer centers four times on different days.

In total, 38.2% of callers never received complete information about supportive care services. Only 37.6% of callers — or 60.8% of those who reached someone who could answer their questions — were told all seven supportive care services were offered.

In 9.5% of calls the office staff provided an answer other than “yes” regarding whether the center offered palliative care. In these cases, the staff said the care was for patients at the end of life only (two calls), there were not doctors who focused on symptom management (three calls), the availability of palliative care depended on a review of medical records (two calls), they were unsure whether palliative care was offered (10 calls) or they did not know what palliative care was (two calls).

When the office staff did not answer “yes” as to whether palliative care services were offered, they instead offered information about a multidisciplinary approach (14.6%), patient navigation (12.1%), genetic assessment (9.5%), psychological services (7.6%) and cancer education services (4.6%).

“As oncologists, we like to believe that when we refer patients to our institution’s helpline, that they will get connected to the services they need, but that doesn’t always happen,” Arif H. Kamal, MD, assistant professor of medicine in the department of medicine at Duke University School of Medicine and an oncologist at Duke Cancer Institute, said in the press release. “It’s important for oncologists to be aware of these barriers and to work to eliminate them.” – by Alexandra Todak

Reference:

Hutchins K, at al. Abstract 122. Scheduled for presentation at: Palliative Care in Oncology Symposium; Sept. 9-10, 2016; San Francisco.

Disclosure: Kamal reports a consultant/advisory role with Insys therapeutics. The other researchers report no relevant financial disclosures.