Perioperative Palliative Care Considerations for Surgical Oncology Nurses

QUESTION ASKED: What are graduate medical education trainees’ attitudes and beliefs regarding palliative care, what is their awareness of the availability and role of palliative care services, and does previous exposure to a palliative care rotation facilitate a better awareness of palliative care? SUMMARY ANSWER: A vast majority of oncology trainees perceived palliative care services to be beneficial for patient care (92%) and were supportive of mandatory palliative care training (74%). Surgical oncology trainees and trainees with no previous palliative care exposure were significantly less likely to consult palliative care and had significantly less awareness of palliative care. METHODS: We conducted an institutional review board–approved online survey to determine awareness of palliative care among graduate medical trainees at MD Anderson. One hundred seventy oncology trainees who completed at least 9 months of training in medical, surgical, gynecologic, and radiation oncology fellowship and residency program during the 2013 academic year completed an online questionnaire. Descriptive, univariate, and multivariate analyses were performed. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Although there was a substantial response rate (78%), the results may not be generalizable as the survey was conducted at a single institution. Also, the frequency of palliative care referrals is self-reported. REAL-LIFE IMPLICATIONS: Our findings suggest that exposure to palliative care training may lead to increased awareness of palliative care among oncologists, and thus, increased overall and early referrals to palliative care. Surgical oncology trainees may benefit from increased exposure to palliative care rotations. More research is needed to characterize the impact of training on referral patterns to palliative care. In the meantime, efforts should be made to include formal palliative care rotations in oncology training. [Table: see text]

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Implementing and Evaluating the COMFORT Communication in Palliative Care Curriculum for Oncology Nurses

Journal of Hospice and Palliative Nursing ◽

10.1097/njh.0000000000000320 ◽

2017 ◽

Vol 19 (2) ◽

pp. 140-146 ◽

Cited By ~ 8

Author(s):

Julie Ann Cronin ◽

Susan Finn

Keyword(s):

Palliative Care ◽

Oncology Nurses

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A qualitative study on oncology nurses’ experiences of providing palliative care in the acute care setting

Proceedings of Singapore Healthcare ◽

10.1177/2010105816660322 ◽

2016 ◽

Vol 26 (1) ◽

pp. 17-25 ◽

Cited By ~ 2

Author(s):

Pei Fen Chuah ◽

Mei Ling Lim ◽

Seow Ling Choo ◽

Guan Yi Woo ◽

Hiu Kwan To ◽

...

Keyword(s):

Palliative Care ◽

Acute Care ◽

Care Setting ◽

Organizational Factors ◽

Oncology Nurses ◽

Acute Care Setting ◽

Oncology Care ◽

Group Interviews ◽

Barriers And Challenges ◽

Nurses Perceptions

Background: With the renewed emphasis on palliative care in Singapore, coupled with a dearth of studies on provision of palliative care in acute services, it is timely to explore the experiences, barriers and challenges faced by oncology nurses in the acute care setting. Aim: This study aimed to explore nurses’ experiences of providing palliative care in the acute oncology care unit. Method: An exploratory descriptive research methodology was adopted. Focus group interviews, involving a total of 24 nurses, were conducted. Interviews were audio-taped and transcribed verbatim. Data was analyzed using an inductive content analysis approach. Results: Five key themes emerged from the analysis: (1) nurses’ perceptions of palliative care; (2) multiple roles of nurses in palliative care; (3) emotional burden of providing palliative care; (4) misconceptions of palliative care; (5) challenges in providing palliative care. Conclusion: The provision of palliative care in the acute care setting remained challenging. This is partly due to the attitudes of patients, families and healthcare workers, as well as organizational factors such as lack of training. Nurses play an important role in giving and facilitating palliative care for patients in the hospitals. Future studies can explore interventions to help overcome the challenges that are impeding nurses from providing high-quality palliative care in the acute care setting.

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Referral Practices of Oncologists to Specialized Palliative Care

Journal of Clinical Oncology ◽

10.1200/jco.2012.44.0248 ◽

2012 ◽

Vol 30 (35) ◽

pp. 4380-4386 ◽

Cited By ~ 142

Author(s):

Kirsten Wentlandt ◽

Monika K. Krzyzanowska ◽

Nadia Swami ◽

Gary M. Rodin ◽

Lisa W. Le ◽

...

Keyword(s):

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

Surgical Oncology ◽

Disease Course ◽

Radiation Oncologists ◽

Canadian Association ◽

Medical Oncologists ◽

Referral Practices ◽

Specialized Palliative Care

Purpose To describe current referral practices of oncologists to specialized palliative care (SPC) and define demographic characteristics, practice situations, and opinions associated with referral. Methods Physician members of the Canadian Association of Medical Oncologists, Canadian Association of Radiation Oncologists, and Canadian Society of Surgical Oncology were invited to participate in an anonymous survey assessing SPC referral practices. Participants received two e-mailed and two mailed invitations. Results The response rate was 72% (603 of 839 physicians); 37% were medical oncologists/hematologists, 50% were radiation oncologists, and 12% were surgical oncologists. Ninety-four percent reported that SPC was available to them, but only 37% reported that these services accepted patients on chemotherapy. Eighty-four percent referred terminally ill patients usually/always, but generally for uncontrolled symptoms or discharge planning late in the disease course. One third would refer to SPC earlier if it was renamed supportive care. Predictors of higher referral frequency included comprehensiveness of available SPC services (P = .004), satisfaction with SPC availability (P < .001), SPC acceptance of patients receiving chemotherapy (P < .001), and oncologist ease with referring patients to a palliative care service before they were close to death (P < .001). Controlling for specialty, predictors of referral at diagnosis or during chemotherapy, rather than later, included satisfaction with SPC service availability (P < .001) and SPC service acceptance of patients on chemotherapy (P < .001). Conclusion Oncologists referred patients frequently to SPC, but generally late in the disease course for patients with uncontrolled symptoms. Availability of comprehensive SPC, especially for patients receiving chemotherapy, and persisting definitional issues seem to be the main barriers preventing timely referral.

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Choosing oncology as specialization: Medical students' perception after clinical rotation in cancer center.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.10528 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 10528-10528

Author(s):

Omar Orlando Castillo Fernandez ◽

Maria Lim ◽

Lilian Hayde Montano ◽

Gaspar Perez-Jimenez ◽

Jhonattan Camaño ◽

...

Keyword(s):

Palliative Care ◽

Medical Students ◽

Radiation Oncology ◽

Cancer Care ◽

Medical Oncology ◽

Surgical Oncology ◽

Cancer Center ◽

Clinical Rotation ◽

Chi Square ◽

Field Methods

10528 Background: Cancer is a leading cause of death worldwide and the demand for oncologist and palliative care specialists is increasing dramatically. Two years ago, The Universidad de Panama incorporated Oncology in the curriculum in order to face the shortage of professionals involved in cancer care. Little information is available concerning young medical students desire to pursue a career in oncology.The aim of this study is to evalute medical students perception about Oncology as a specialization field. Methods: An electronic survey was sent to medical students from Universidad de Panama after finishing Oncology rotation the last 2 years. Chi square and Mann Whitney U tests were used to compare variables. Results: 145 questionnaries were responded (40%). 60% female and 40% male. Median age was 25 years old. Clinical rotation during Oncology practices were: 37% in Medical Oncology, 24% in Surgical Oncology, 21% in Radiation Oncology and 18% in Palliative Care. 20% (29) of students are highly motivated to pursue a career in Oncology. 8 in Radiation Oncology. 8 in Surgical Oncology, 8 in Medical Oncology and 5 in Palliative Care. Variable associated with a oncology preference were: male gender (p=0.007), lack of human resources (p=0.009), contact with patients and family (p=0.005), good experience with mentor (p=0.002), nature and complexity of disease (p<0.001). Potential emotional burden was negatively asssociated (p=0.004) with oncology preference. 66% of students acknowledged that clinical rotation changed positively their perception about cancer patient care and a third of students haved not rule out the possibility to choose Oncology in the near future. Conclusions: Early exposition to medical student to cancer care might help to reduce the global shortage of oncologist and palliative specialists.

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Palliative care outcomes in surgical oncology patients with advanced malignancies: a mixed methods approach

Quality of Life Research ◽

10.1007/s11136-011-0065-7 ◽

2011 ◽

Vol 21 (3) ◽

pp. 405-415 ◽

Cited By ~ 18

Author(s):

Gwenyth R. Wallen ◽

Karen Baker ◽

Marilyn Stolar ◽

Claiborne Miller-Davis ◽

Nancy Ames ◽

...

Keyword(s):

Palliative Care ◽

Mixed Methods ◽

Surgical Oncology ◽

Oncology Patients ◽

Mixed Methods Approach ◽

Advanced Malignancies ◽

Care Outcomes

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Palliative care and pediatric surgical oncology

Seminars in Pediatric Surgery ◽

10.1053/j.sempedsurg.2016.08.001 ◽

2016 ◽

Vol 25 (5) ◽

pp. 323-332 ◽

Cited By ~ 5

Author(s):

Alessandro Inserra ◽

Alessandra Narciso ◽

Guglielmo Paolantonio ◽

Raffaella Messina ◽

Alessandro Crocoli

Keyword(s):

Palliative Care ◽

Surgical Oncology

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Palliative care from cancer diagnosis for all: Memorial Sloan Kettering’s “One-Two-Three” program.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.111 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 111-111 ◽

Cited By ~ 2

Author(s):

Andrew S. Epstein ◽

Virginia M. Klimek ◽

Kimberly Chow ◽

Anjali V. Desai ◽

Peter Justin Wan ◽

...

Keyword(s):

Palliative Care ◽

Unmet Need ◽

High Volume ◽

Core Values ◽

Oncology Nurses ◽

Health Care Proxy ◽

Care Needs ◽

Information Preferences ◽

Communication Needs ◽

Hospice Use

111 Background: Early, universal palliative care is an unmet need for cancer patients. Our new program aims to provide palliative care, by primary oncology teams with support from palliative care specialists, from diagnosis as an institutional standard. Methods: One-Two-Three is a structured program of assessment and response addressing palliative care needs regardless of cancer stage or prognosis starting with the first 3 visits after diagnosis. Assessments include patient physical/emotional/spiritual symptoms (10 symptoms, self-reported 0-10), communication needs (information preferences, illness understanding), and proactive care planning through exploration of core values. As first responders, oncology nurses are guided by “ready responses” in an empathic framework and coaching or direct patient consultation by palliative care specialists. Feasibility, acceptability, and impact on patient, caregiver, and utilization outcomes are evaluated quantitatively and qualitatively. Results: Assessments were piloted with 25 consecutive, newly-diagnosed patients in blood cancer and solid tumor clinics. Symptom and communication assessments each took < 5 minutes and showed high prevalence of moderate/severe distress ( > 50% for 8/10 symptoms, 144 assessments), variation in information preferences (76% wanting detail, 24% broad overview only), and unmet communication needs. All but 1 patient without a health care proxy chose one. Oncology nurses engaged patients in structured discussions ( < 15 minutes) of core values. Clinic workflow was maintained. Patients, families, and oncology clinicians endorsed the initiative. As palliative care skills of oncology teams improved, specialists focused on more complex issues. Conclusions: Routine interprofessional primary palliative care with specialist support from diagnosis is feasible and acceptable in our center’s high-volume outpatient oncology clinics. Ongoing evaluations will assess other outcomes (e.g., quality of life); impact on clinicians/ processes; and utilization (e.g., ED/hospital visits, hospice use).

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