Gynecologic Oncologist Views Influencing Referral to Outpatient Specialty Palliative Care

Casey M. Hay*, Carolyn Lefkowits, Megan Crowley-Matoka, Marie A. Bakitas, Leslie H. Clark, Linda R. Duska, Renata R. Urban, Lee May Chen, Stephanie L. Creasy, Yael Schenker

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Objective: Early specialty palliative care is underused for patients with advanced gynecologic malignancies. We sought to understand how gynecologic oncologists' views influence outpatient specialty palliative care referral to help inform strategies for improvement. Methods/Materials We conducted a qualitative interview study at 6 National Cancer Institute-designated cancer centers with well-established outpatient palliative care services. Between September 2015 and March 2016, 34 gynecologic oncologists participated in semistructured telephone interviews focused on attitudes, experiences, and preferences related to outpatient specialty palliative care. A multidisciplinary team analyzed transcripts using constant comparative methods to inductively develop a coding framework. Through an iterative, analytic process, codes were classified, grouped, and refined into themes. Results: Mean (SD) participant age was 47 (10) years. Mean (SD) interview length was 25 (7) minutes. Three main themes emerged regarding how gynecologic oncologists view outpatient specialty palliative care: (1) long-term relationships with patients is a unique and defining aspect of gynecologic oncology that influences referral, (2) gynecologic oncologists value palliative care clinicians' communication skills and third-party perspective to increase prognostic awareness and help negotiate differences between patient preferences and physician recommendation, and (3) gynecologic oncologists prefer specialty palliative care services embedded within gynecologic oncology clinics. Conclusions: Gynecologic oncologists value longitudinal relationships with patients and use specialty palliative care to negotiate conflict surrounding prognostic awareness or the treatment plan. Embedding specialty palliative care within gynecologic oncology clinics may promote communication between clinicians and facilitate gynecologic oncologist involvement throughout the illness course.

Original languageEnglish (US)
Pages (from-to)588-596
Number of pages9
JournalInternational Journal of Gynecological Cancer
Volume27
Issue number3
DOIs
StatePublished - Mar 1 2017

Keywords

  • Early integration
  • Palliative care
  • Qualitative research

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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