Do Patients with Advanced Cancer and Unmet Palliative Care Needs Have an Interest in Receiving Palliative Care Services?

Abstract

Background: It is not known whether unmet palliative care needs are associated with an interest in palliative care services among patients with advanced cancer receiving ongoing oncology care. Objective: To assess the association between unmet palliative care needs and patient interest in subspecialty palliative care services. Design: Cross-sectional telephone survey. Subjects and setting: One hundred sixty-nine patients with advanced cancer receiving care from 20 oncologists at two academic cancer centers. Measurements: Surveys assessed palliative care needs in six domains. Patients were read a description of palliative care and then asked three questions about their current interest in subspecialty palliative care services (perceived need, likelihood of requesting, willingness to see if their oncologist recommended; all outcomes on 0-10 Likert scale). Results: The vast majority of patients described unmet palliative care needs, most commonly related to psychological/emotional distress (62%) and symptoms (62%). In fully adjusted models accounting for clustering by oncologist, unmet needs in these domains were associated with a higher perceived need for subspecialty palliative care services (psychological/emotional needs odds ratio [OR] 1.30; 95% confidence interval [CI] 1.06-1.58; p = 0.01; symptom needs OR 1.27; 95% CI 1.01-1.60; p = 0.04). There was no significant association between unmet needs and likelihood of requesting palliative care services. Willingness to see palliative care if oncologist recommended was high (mean 8.6/10, standard deviation [SD] 2). Conclusion: Patients with advanced cancer and unmet symptom and psychological/emotional needs perceive a high need for subspecialty palliative care services but may not request them. Efforts to increase appropriate use of subspecialty palliative care for cancer may require oncologist-initiated referrals.

Education, implementation, and policy barriers to greater integration of palliative care: A literature review

“…50 More than 60% of patients reported unmet needs, primarily characterized as psychological/emotional or symptom-specific, and both were significantly associated with self-perceived need for palliative care services. The presence of these needs, however, was not associated with the likelihood that patients would initiate a request for services.…”

Care Management by Oncology Nurses To Address Palliative Care Needs: A Pilot Trial To Assess Feasibility, Acceptability, and Perceived Effectiveness of the CONNECT Intervention

“…29 Even when available, many patients and oncologists are reluctant to utilize specialty palliative care services-either because of practical concerns (e.g., additional travel time or costs), or because they equate palliative care with death and dying. [30][31][32][33][34][35] Furthermore, without better coordination, cancer care provided by multiple clinicians across settings can lead to treatment and communication errors. 36 In light of these constraints, interventions that address deficient palliative care processes within oncology clinics are needed, while preserving use of specialty palliative care for patients with the greatest needs.…”

Integrating Function‐Directed Treatments into Palliative Care

“…It is also useful to consider the results of needs assessments conducted among multi‐morbid patients with progressive illnesses [13‐15]. These inventories identify that most patients prioritize a need for help in understanding their condition's anticipated impact on function, and other QoL domains.…”