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B. Le



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    O19 - Support and Palliation I (ID 138)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Nurses
    • Presentations: 1
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      O19.03 - Perceptions and attitudes to early integration of palliative care for patients with incurable lung cancer (ID 2588)

      10:30 - 12:00  |  Author(s): B. Le

      • Abstract
      • Presentation
      • Slides

      Background
      Lung cancer is the leading cause of death from cancer in Australia with the majority of patients diagnosed with late stage incurable disease. Although there is evidence of patient benefit from early involvement with specialist palliative care, this may not translate into clinical practice. The aim of this study was to explore clinicians’ perceptions and attitudes to Palliative Care referral.

      Methods
      A modified validated self-report palliative care referral questionnaire (Johnson, 2008) was given to doctors and nurses working in the multi-disciplinary lung cancer teams at three teaching hospitals in metropolitan Melbourne. Participants were asked whether listed items had contributed to referral (9 triggers) or non referral (15 barriers) of their patients. Level of agreement with 22 attitudinal and perception items explored clinicians’ views about palliative care.

      Results
      55 questionnaires were distributed and 42 completed (76% response rate). Respondents had a median of 6 years (interquartile range 3-12) of experience practicing in their specialty. One-third (14/42) were doctors working in Medical Oncology, 26% (11/42) in Respiratory Medicine, 19% (8/42) in Radiation Oncology, and 12%, (5/42) in Surgical Oncology, plus two oncology nurses and one physician trainee.93% of respondents agreed that early referral to Palliative Care is beneficial to patients and 95% agreed that Palliative Care can benefit patients receiving active treatment. The majority (69%) of clinicians believe that their relationship with the patient continues when she/he elects to have specialist palliative care. 71% indicated that it is not difficult to refer a patient they have cared for a long time and have a close relationship with. Almost two-thirds (64%) disagreed that when they first bring up palliative care patients give up hope. However, only 60% of respondents agreed that all advanced cancer patients should be referred to Palliative Care. The most frequently cited reasons for referral were for physical symptoms. The majority reported that Palliative Care is either very important or important for patients with psycho-social issues or foreseeable future psycho-social issues, yet only half of respondents agreed that psycho-social issues would trigger a referral to Palliative Care. When asked for the main reasons for not referring to Palliative Care, 60% agreed they do not refer when the patient has no symptoms and 60% also agreed they do not refer if they can manage the patients’ symptoms themselves. However, only 38% of clinicians reported they were well trained to take care of the symptoms of advanced cancer patients. Issues related to patients not understanding or accepting their prognosis were cited as barriers to referral by more than a third of clinicians.

      Conclusion
      Clinicians involved in the care of patients with incurable lung cancer have positive perceptions and attitudes to Palliative Care but this may not translate into routine referral of all patients with incurable lung cancer. In order to make referral routine, we need education around the perception that only patients with unmanageable symptoms benefit from referral to Palliative Care. Furthermore, additional training of oncologists about symptom management appears desirable since a significant proportion reported a deficiency in this area.

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    O26 - Support and Palliation II (ID 140)

    • Event: WCLC 2013
    • Type: Oral Abstract Session
    • Track: Nurses
    • Presentations: 1
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      O26.03 - Is early integration of palliative care for patients with incurable lung cancer acceptable to Australian healthcare professionals? (ID 2596)

      16:15 - 17:45  |  Author(s): B. Le

      • Abstract
      • Presentation
      • Slides

      Background
      In a recent landmark US study, metastatic NSCLC patients who received palliative care from the time of diagnosis concurrently with standard oncology management reported improvements in quality-of-life, symptom control, reduction in “aggressive therapies” at end-of-life, and a survival advantage compared to those receiving standard oncology management alone. The aim of this qualitative sub-study was to explore Australian health care professionals’ perceptions of early integration of palliative care for patients with incurable lung cancer.

      Methods
      Members of the lung cancer multi-disciplinary teams of three large metropolitan teaching hospitals in Melbourne were invited to attend a focus group discussion. Data from focus groups were supplemented with interviews from a purposive sample of individual health care providers who were unable to attend the groups. Participants were asked to describe barriers and facilitators to implementation of a model of early integration of palliative care.

      Results
      Three focus groups and six individual interviews were conducted with 28 health care professionals. Key facilitators and barriers to referral (see table) were grouped into 4 themes: 1. Trust; 2. Care Coordination; 3. Ease of Referral; and 4. Perceived patient/family reaction.

      Key themes Issues discussed as facilitators / or barriers
      Trust 1. Confidence in the quality of the palliative care service 2. Palliative care poses a threat to the referrer 3. Past experience with community palliative care
      Care Coordination 1. Integration of concurrent palliative care and "active treatment" 2. Concern about adding to fragmented care and lack of co-ordination 3. Effective Communication between care providers
      Ease of Referral 1. The value of a physical presence of the palliative care provider in the clinic 2. Perception of limited resources
      Perceived patient/family reaction 1. Cultural perceptions about what referral to palliative care means 2. Concern about patient and/or family reaction to referral leading to distress and loss of hope

      Conclusion
      Early involvement of palliative care in patients with incurable lung cancer is acceptable to the majority of treating clinicians. Palliative care services must be embedded into the system, sufficiently resourced and of high quality. For early referral to occur the model ideally involves a physical presence of a palliative care clinician in clinic who is easily accessible for referrals and considered a core team member.

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