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Transplant physicians have ‘substantial concerns’ regarding palliative care services
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SALT LAKE CITY — Hematopoietic stem cell transplant physicians reported substantial concerns about palliative care clinicians’ knowledge about transplant, according to results of a cross-sectional, web-based survey presented at the BMT Tandem Meetings.
“We demonstrate that the majority of transplant physicians trust palliative care clinicians, but they do have substantial concerns about palliative care clinicians’ knowledge about transplant, as well as how patients perceive palliative care,” Areej El-Jawahri, MD, director of the bone marrow transplant survivorship program at Massachusetts General Hospital, and associate director of Massachusetts General Hospital Cancer Center Survivorship Program, told HemOnc Today. “This is an important study underscoring the potential barriers for enhancing palliative care utilization [among] patients undergoing hematopoietic stem cell transplantation.”
Previous studies have suggested a substantial benefit for palliative care involvement in caring for patients undergoing HSCT. However, palliative care services are rarely consulted for these patients. Cultural barriers and misperceptions of palliative care likely contribute to a lack of collaboration between HSCT and palliative care.
“Understanding barriers to such integration is very important,” El-Jawahri said.
El-Jawahri and colleagues recruited transplant physicians from the American Society for Blood and Marrow Transplantation membership list to answer a 28-item survey adapted from prior studies to evaluate their access to palliative care services, as well as perceptions and attitudes about palliative care.
Of 1,005 eligible transplant physicians, 28% completed the questionnaire. The majority of the physicians were white (70%), non-Hispanic or Latino (70%), and male (65%). Thirty-six percent of physicians had less than 10 years of practice, 29% had 10 to 20 years, and 35% had more than 20 years.
Researchers created a composite score of physicians’ attitudes about palliative care and used linear regression to measure predictors of physicians’ attitudes about palliative care in an exploratory analysis.
Results showed physicians collaborated with palliative care services more often for inpatient care (44%) than outpatient care (21%). Forty-five percent of physicians considered inpatient palliative care services excellent, compared with 30% for outpatient palliative care services.
Many physicians reported feeling they should coordinate the care of their patients across all stages of disease, including at the end of life (84%). Seventy-six percent of physicians stated they trusted palliative care clinicians to care for their patients, but 40% reported palliative care clinicians did not have enough understanding to counsel their patients regarding treatment following HSCT.
Eighty-two percent of physicians reported that when their patients heard the term palliative care, they felt scared. Most physicians reported that the service name “palliative care” was a barrier to its use.
Factors associated with a positive physician attitude toward palliative care included female gender ( = 0.85; standard error [SE] = 0.38; P = .024), 10 to 20 years of clinical practice ( = 1.29; SE = 0.48; P = .0077), degree of collaboration with palliative care teams ( = 0.44; SE = 0.16; P = .0072) and perceived quality of palliative care services ( = 0.44; SE = 0.10; P = < .0001).
Physicians more likely to have a negative attitude toward palliative care included those who perceived the palliative care name as a barrier for use ( = -0.12; SE = 0.06; P = .0473) and who had higher sense of ownership over their patients’ care ( = -0.35; SE = 0.08; P < .0001).
Because physicians’ perception of patients’ understanding of the term palliative care raised concerns, El-Jawahri said researchers plan to conduct a survey to assess patients’ perceptions of palliative care.
“Studies in solid tumor oncology have suggested that patients actually do not know what palliative care is and do not hold any positive or negative perceptions of palliative care. If we can show the transplant community that patients undergoing transplantation also do not have any negative associations with palliative care, that would be helpful,” El-Jawahri said.
More models of palliative care integration also are needed.
“Through the course of this trial, we were able to create a trusting relationship between our palliative care clinicians and transplant physicians that overcame some of the barriers identified in this study,” El-Jawahri said. “We, therefore, need to test more models of palliative care integration that allow transplant and palliative care clinicians to work together to improve the care of our patients and their families.” – by Melinda Stevens
Reference:
El-Jawahri AR, et al. Abstract 32. Presented at: BMT Tandem Meetings; Feb. 21-25, 2018; Salt Lake City.
Disclosures: El-Jawahri and the other study authors reports no relevant financial disclosures.