Radiation Oncologists' Role in End-Of-Life Care

A Perspective From Medical Oncologists

Jeffrey P. Gross, Jacqueline M. Kruser, Margaret R. Moran, Karen Kaiser, Eytan Szmuilowicz, Sheetal Mehta Kircher, Timothy Joseph Kruser*

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: Multidisciplinary communication and collaboration are key to planning and delivering end-of-life care for patients with advanced and metastatic cancer. We sought to characterize medical oncologists' perspectives on the role of radiation oncologists in end-of-life care. Materials and Methods: A sample of US medical oncologists was recruited using snowball sampling methods. Audio recordings of 4 professionally moderated focus groups were transcribed. Investigators from diverse backgrounds (medical oncology, radiation oncology, critical care medicine, palliative care, and public health) independently reviewed each transcript. Qualitative content analysis was used to create consensus codes that were applied to subsequent focus group transcripts in an iterative process. Results: Medical oncologists expressed complex views regarding the role of radiation oncologists in end-of-life care. Identified themes included the limited role of radiation oncologists, territorial concerns, capability, and desire of radiation oncologists in this realm, and the need for communication between providers. Radiation oncologists were compared with surgeons, whose interaction with patients ceased after their service had been performed. In this regard, control of palliative care referral or end-of-life care discussions was thought to be in the territory of medical oncologists who had longitudinal relationships with patients from diagnosis. Medical oncologists were concerned about the capability of radiation oncologists to accurately prognosticate, and stated radiation oncologists lacked knowledge of subsequent lines of systemic therapy available to patients. Radiation oncologists' fear of upsetting medical oncologists was thought to be justified if they engaged in end-of-life care planning without direct permission from the referring medical oncologist. Conclusions: Participation of radiation oncologists in end-of-life care planning was viewed with skepticism by medical oncologists. Radiation oncologists should focus on increasing open communication and teamwork with medical oncologists and demonstrate their ability to prognosticate and counsel patients regarding end-of-life care decisions.

Original languageEnglish (US)
Pages (from-to)362-370
Number of pages9
JournalPractical Radiation Oncology
Volume9
Issue number5
DOIs
StatePublished - Sep 1 2019

Fingerprint

Terminal Care
Focus Groups
Interdisciplinary Communication
Communication
Oncologists
Radiation Oncologists
Radiation Oncology
Aptitude
Medical Oncology
Critical Care
Palliative Care
Fear
Consensus
Referral and Consultation
Public Health
Research Personnel

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

@article{68f44e08b6be43f291f3cfa51e1b730d,
title = "Radiation Oncologists' Role in End-Of-Life Care: A Perspective From Medical Oncologists",
abstract = "Purpose: Multidisciplinary communication and collaboration are key to planning and delivering end-of-life care for patients with advanced and metastatic cancer. We sought to characterize medical oncologists' perspectives on the role of radiation oncologists in end-of-life care. Materials and Methods: A sample of US medical oncologists was recruited using snowball sampling methods. Audio recordings of 4 professionally moderated focus groups were transcribed. Investigators from diverse backgrounds (medical oncology, radiation oncology, critical care medicine, palliative care, and public health) independently reviewed each transcript. Qualitative content analysis was used to create consensus codes that were applied to subsequent focus group transcripts in an iterative process. Results: Medical oncologists expressed complex views regarding the role of radiation oncologists in end-of-life care. Identified themes included the limited role of radiation oncologists, territorial concerns, capability, and desire of radiation oncologists in this realm, and the need for communication between providers. Radiation oncologists were compared with surgeons, whose interaction with patients ceased after their service had been performed. In this regard, control of palliative care referral or end-of-life care discussions was thought to be in the territory of medical oncologists who had longitudinal relationships with patients from diagnosis. Medical oncologists were concerned about the capability of radiation oncologists to accurately prognosticate, and stated radiation oncologists lacked knowledge of subsequent lines of systemic therapy available to patients. Radiation oncologists' fear of upsetting medical oncologists was thought to be justified if they engaged in end-of-life care planning without direct permission from the referring medical oncologist. Conclusions: Participation of radiation oncologists in end-of-life care planning was viewed with skepticism by medical oncologists. Radiation oncologists should focus on increasing open communication and teamwork with medical oncologists and demonstrate their ability to prognosticate and counsel patients regarding end-of-life care decisions.",
author = "Gross, {Jeffrey P.} and Kruser, {Jacqueline M.} and Moran, {Margaret R.} and Karen Kaiser and Eytan Szmuilowicz and Kircher, {Sheetal Mehta} and Kruser, {Timothy Joseph}",
year = "2019",
month = "9",
day = "1",
doi = "10.1016/j.prro.2019.04.001",
language = "English (US)",
volume = "9",
pages = "362--370",
journal = "Practical Radiation Oncology",
issn = "1879-8500",
publisher = "Elsevier BV",
number = "5",

}

Radiation Oncologists' Role in End-Of-Life Care : A Perspective From Medical Oncologists. / Gross, Jeffrey P.; Kruser, Jacqueline M.; Moran, Margaret R.; Kaiser, Karen; Szmuilowicz, Eytan; Kircher, Sheetal Mehta; Kruser, Timothy Joseph.

In: Practical Radiation Oncology, Vol. 9, No. 5, 01.09.2019, p. 362-370.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Radiation Oncologists' Role in End-Of-Life Care

T2 - A Perspective From Medical Oncologists

AU - Gross, Jeffrey P.

AU - Kruser, Jacqueline M.

AU - Moran, Margaret R.

AU - Kaiser, Karen

AU - Szmuilowicz, Eytan

AU - Kircher, Sheetal Mehta

AU - Kruser, Timothy Joseph

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Purpose: Multidisciplinary communication and collaboration are key to planning and delivering end-of-life care for patients with advanced and metastatic cancer. We sought to characterize medical oncologists' perspectives on the role of radiation oncologists in end-of-life care. Materials and Methods: A sample of US medical oncologists was recruited using snowball sampling methods. Audio recordings of 4 professionally moderated focus groups were transcribed. Investigators from diverse backgrounds (medical oncology, radiation oncology, critical care medicine, palliative care, and public health) independently reviewed each transcript. Qualitative content analysis was used to create consensus codes that were applied to subsequent focus group transcripts in an iterative process. Results: Medical oncologists expressed complex views regarding the role of radiation oncologists in end-of-life care. Identified themes included the limited role of radiation oncologists, territorial concerns, capability, and desire of radiation oncologists in this realm, and the need for communication between providers. Radiation oncologists were compared with surgeons, whose interaction with patients ceased after their service had been performed. In this regard, control of palliative care referral or end-of-life care discussions was thought to be in the territory of medical oncologists who had longitudinal relationships with patients from diagnosis. Medical oncologists were concerned about the capability of radiation oncologists to accurately prognosticate, and stated radiation oncologists lacked knowledge of subsequent lines of systemic therapy available to patients. Radiation oncologists' fear of upsetting medical oncologists was thought to be justified if they engaged in end-of-life care planning without direct permission from the referring medical oncologist. Conclusions: Participation of radiation oncologists in end-of-life care planning was viewed with skepticism by medical oncologists. Radiation oncologists should focus on increasing open communication and teamwork with medical oncologists and demonstrate their ability to prognosticate and counsel patients regarding end-of-life care decisions.

AB - Purpose: Multidisciplinary communication and collaboration are key to planning and delivering end-of-life care for patients with advanced and metastatic cancer. We sought to characterize medical oncologists' perspectives on the role of radiation oncologists in end-of-life care. Materials and Methods: A sample of US medical oncologists was recruited using snowball sampling methods. Audio recordings of 4 professionally moderated focus groups were transcribed. Investigators from diverse backgrounds (medical oncology, radiation oncology, critical care medicine, palliative care, and public health) independently reviewed each transcript. Qualitative content analysis was used to create consensus codes that were applied to subsequent focus group transcripts in an iterative process. Results: Medical oncologists expressed complex views regarding the role of radiation oncologists in end-of-life care. Identified themes included the limited role of radiation oncologists, territorial concerns, capability, and desire of radiation oncologists in this realm, and the need for communication between providers. Radiation oncologists were compared with surgeons, whose interaction with patients ceased after their service had been performed. In this regard, control of palliative care referral or end-of-life care discussions was thought to be in the territory of medical oncologists who had longitudinal relationships with patients from diagnosis. Medical oncologists were concerned about the capability of radiation oncologists to accurately prognosticate, and stated radiation oncologists lacked knowledge of subsequent lines of systemic therapy available to patients. Radiation oncologists' fear of upsetting medical oncologists was thought to be justified if they engaged in end-of-life care planning without direct permission from the referring medical oncologist. Conclusions: Participation of radiation oncologists in end-of-life care planning was viewed with skepticism by medical oncologists. Radiation oncologists should focus on increasing open communication and teamwork with medical oncologists and demonstrate their ability to prognosticate and counsel patients regarding end-of-life care decisions.

UR - http://www.scopus.com/inward/record.url?scp=85068558973&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068558973&partnerID=8YFLogxK

U2 - 10.1016/j.prro.2019.04.001

DO - 10.1016/j.prro.2019.04.001

M3 - Article

VL - 9

SP - 362

EP - 370

JO - Practical Radiation Oncology

JF - Practical Radiation Oncology

SN - 1879-8500

IS - 5

ER -