Presuppositions, cost–benefit, collaboration, and competency impacts palliative care referral in paediatric oncology: a qualitative study

BMC Palliative Care

Research

Naveen Salins¹  Sean Hughes²  Nancy Preston² 

[1] Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, India;Manipal Academy of Higher Education, 576104, Manipal, Karnataka, India;Division of Health Research, Health Innovation One, Lancaster University, Sir John Fisher Drive, LA1 4AT, Lancaster, UK;

关键词: Oncologists;    Haematologists;    Child;    Cancer;    Referral;    Palliative care;   

DOI  :  10.1186/s12904-022-01105-0

 received in 2022-07-10, accepted in 2022-11-14,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundAlthough a significant proportion of children with cancer need palliative care, few are referred or referred late, with oncologists and haematologists gatekeeping the referral process. We aimed to explore the facilitators and barriers to palliative care referral.MethodsTwenty-two paediatric oncologists and haematologists were purposively recruited and interviewed. Data were analysed using reflexive thematic analysis. Findings were interpreted using the critical realist paradigm.ResultsFour themes were generated. 1) Oncologists expressed concern about the competency of palliative care teams. Palliative care often symbolised therapeutic failure and abandonment, which hindered referral. Trustworthy palliative care providers had clinical competence, benevolence, and knowledge of oncology and paediatrics. 2) Making a palliative care referral was associated with stigma, navigating illness-related factors, negative family attitudes and limited resources, impeding palliative care referral. 3) There were benefits to palliative care referral, including symptom management and psychosocial support for patients. However, some could see interactions with the palliative care team as interference hindering future referrals. 4) Suggested strategies for developing an integrated palliative care model include evident collaboration between oncology and palliative care, early referral, rebranding palliative care as symptom control and an accessible, knowledgeable, and proactive palliative care team.ConclusionPresuppositions about palliative care, the task of making a referral, and its cost-benefits influenced referral behaviour. Early association with an efficient rebranded palliative care team might enhance integration.

【 授权许可】

CC BY   
© The Author(s) 2022

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