Barriers to the Collaboration Between Hematologists and Palliative Care Teams on Relapse or Refractory Leukemia and Malignant Lymphoma Patients’ Care

Morikawa, Miharu; Shirai, Yuki; Ochiai, Ryota; Miyagawa, Kiyoshi

doi:10.1177/1049909115611081

Cited by 22 publications

(39 citation statements)

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“…This is the first UK study to explore SPC doctors’ and nurses’ perceptions about the referral of patients with haematological cancers to their services. Our findings overlap those arising from research conducted with haematologists [ 22 – 24 ], thus confirming and complementing these studies’ results. New insights we offer include SPC clinicians’ perspectives that their role is not always well understood by haematologists, as well as their perceptions of the importance of co-location of services in promoting and enhancing role clarity and closer working patterns.…”

Section: Discussionsupporting

confidence: 91%

“…In our own study, co-location of services was considered an important means of promoting more integrated working patterns, through frequent opportunities for informal contact between clinicians that contributed to relationship building. Two non-UK qualitative studies examining barriers to SPC referral from the haematologists’ and palliative care specialists’ perspectives also show clear overlap with our findings, with difficulties identifying the end of life phase noted as a particular barrier to SPC referral [ 22 , 26 ]. Interestingly, the strong patient-clinician relationship, perceived as reflective of quality care by some [ 47 ], was considered a barrier to the initiation of timely end of life discussions by others [ 26 ].…”

Section: Discussionsupporting

confidence: 64%

“…Referral practices are increasingly the focus of international research (based mainly on reviews of patient records, but also some qualitative studies with haematologists), which provides insights into reasons for late or non-referral of patients with haematological malignancies [ 22 – 26 ]. A recent integrative systematic review, for example, highlights reluctance on the part of haematologists to refer to SPC services due to differing treatment goals, prognostic difficulties, and preference of haematology specialists to manage palliative care, as barriers to referral [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

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Palliative care specialists’ perceptions concerning referral of haematology patients to their services: findings from a qualitative study

et al. 2018

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BackgroundHaematological malignancies (leukaemias, lymphomas and myeloma) are complex cancers that are relatively common, affect all ages and have divergent outcomes. Although the symptom burden of these diseases is comparable to other cancers, patients do not access specialist palliative care (SPC) services as often as those with other cancers. To determine the reasons for this, we asked SPC practitioners about their perspectives regarding the barriers and facilitators influencing haematology patient referrals.MethodsWe conducted a qualitative study, set within the United Kingdom’s (UK’s) Haematological Malignancy Research Network (HMRN: www.hmrn.org), a population-based cohort in the North of England. In-depth, semi-structured interviews were conducted with 20 SPC doctors and nurses working in hospital, community and hospice settings between 2012 and 2014. Interviews were digitally audio-recorded, transcribed and analysed for thematic content using the ‘Framework’ method.ResultsStudy participants identified a range of barriers and facilitators influencing the referral of patients with haematological malignancies to SPC services. Barriers included: the characteristics and pathways of haematological malignancies; the close patient/haematology team relationship; lack of role clarity; late end of life discussions and SPC referrals; policy issues; and organisational issues. The main facilitators identified were: establishment of inter-disciplinary working patterns (co-working) and enhanced understanding of roles; timely discussions with patients and early SPC referral; access to information platforms able to support information sharing; and use of indicators to ‘flag’ patients’ needs for SPC. Collaboration between haematology and SPC was perceived as beneficial and desirable, and was said to be increasing over time.ConclusionsThis is the first UK study to explore SPC practitioners’ perceptions concerning haematology patient referrals. Numerous factors were found to influence the likelihood of referral, some of which related to the organisation and delivery of SPC services, so were amenable to change, and others relating to the complex and unique characteristics and pathways of haematological cancers. Further research is needed to assess the extent to which palliative care is provided by haematology doctors and nurses and other generalists and ways in which clinical uncertainty could be used as a trigger, rather than a barrier, to referral.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

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Palliative care specialists’ perceptions concerning referral of haematology patients to their services: findings from a qualitative study

et al. 2018

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“…Palliative care integration early in the disease course can help to address these aggressive end-of-life interventions and improve patients’ quality of life in other advanced cancer settings(13-18), but the unpredictable nature of blood cancers and the general attitudes of some hematologic oncologists towards palliative care provide several barriers to increased access(7, 19-21). Despite these barriers, a trend towards increased palliative care referral has been observed(22), along with a renewed call to examine the intersection between palliative care and the quality of life of blood cancer patients(23, 24), especially amid initial evidence of feasibility and efficacy in subpopulations such as those undergoing stem cell transplantations(25).…”

Section: Introductionmentioning

confidence: 99%

Comparing the Palliative Care Needs of Patients With Hematologic and Solid Malignancies

Hochman

Wolf

et al. 2018

Journal of Pain and Symptom Management

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Context Hematologic cancer patients use palliative care services less frequently than their solid tumor counterparts. Prior work suggests these patients have a sizeable symptom burden, but comparisons between hematologic and solid tumor patients near the end of life are limited. Objectives To compare unmet symptom needs in a cohort of hematologic and solid tumor patients referred to specialty palliative care services. Methods Using a novel data registry of initial palliative care encounters, we performed a cross-sectional analysis of cancer patients receiving care across seventeen sites within the Global Palliative Care Quality Alliance. We compared clinically-significant symptoms (rated as 4 or greater in severity) between hematologic and solid tumor patients and performed multivariate logistic regression analyses examining the relationship between symptom burden and tumor type. Results We identified 1,235 cancer patients, 108 of which had hematologic malignancies. Pain, dyspnea, nausea, and anorexia burden was as high among patients with hematologic as those with solid malignancies. Blood cancer patients had higher rates of clinically-significant tiredness (51% vs. 42%; p=0.03) than solid tumor patients. Finally, blood cancer patients had greater odds of being tired (odds ratio, 2.19; CI 1.22-3.91) and drowsy (odds ratio, 1.81; CI 1.07-3.07) than solid tumor patients independent of age, gender, race, and performance status. Conclusions Hematologic and solid tumor patients both have significant symptom burden at time of referral to palliative care services. Blood cancer patients may have unique concerns warranting targeted attention, including substantial drowsiness and tiredness. Our findings suggest a need to optimize palliative care usage in the hematologic cancer population.

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“…However, hematologists and palliative care specialists share perceptions on potential barriers. These include not feeling the need to refer, the difficulty of adequate referral timing, the lack of aggressive approach, the negative image of the hospital-based SPC teams, the need for hematologic malignancy-oriented management, and lack of communication [34]. …”

Section: Barriers and Facilitators For Integration Of Palliative Carementioning

confidence: 99%

Palliative Care in Patients with Hematological Malignancies

Oechsle¹

2018

Oncol Res Treat

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Patients with hematologic malignancies (HM) nowadays rarely receive palliative or hospice care, and studies on potential effects of integrated palliative care are rare. This narrative review provides a comprehensive overview on their current end-of-life care, first data on integrated specialist palliative care (SPC) and potential barriers. Symptom burden and distress in patients with HM seem to be comparable to other cancer patients, but their performance status and specific symptoms are even worse. Prolongation of life usually remains the main focus until the last days or weeks of life. Their chance to die in hospital is twice as high, but their chance to receive specialist palliative or hospice care is only half of that of other cancer patients. Prospective studies indicate a high acceptability and positive effects of integrated SPC, e.g. clarification of treatment goals, stabilization of quality of life, decreased depression, anxiety, symptom burden, and post-traumatic stress disorders. Interdisciplinary cooperation, timely discussions about SPC referral, and indicators to ‘flag' patients in need for SPC are important, but they are largely missing. In conclusion, further studies have to evaluate factors identifying patients with HM in need for SPC. Further models of early integrated palliative care should be evaluated in prospective studies and established in daily clinical practice.

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Barriers to the Collaboration Between Hematologists and Palliative Care Teams on Relapse or Refractory Leukemia and Malignant Lymphoma Patients’ Care

Abstract: We have identified hematologists' and palliative care specialists' perceptions of the HPCT's roles and the barriers to their collaboration. A better understanding of such barriers may lead to effective collaboration between hematologists and the HPCT.

Cited by 22 publications

References 35 publications

Palliative care specialists’ perceptions concerning referral of haematology patients to their services: findings from a qualitative study

Palliative care specialists’ perceptions concerning referral of haematology patients to their services: findings from a qualitative study

Comparing the Palliative Care Needs of Patients With Hematologic and Solid Malignancies

Palliative Care in Patients with Hematological Malignancies

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