bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oncologists' attitudes towards patient and family-centered care.
Authors: Nguyen Timothy K. , Bauman Glenn , Watling Christoper J , Hahn Karin 
Published: February 2017

111 Background: Patient and family-centered care (PFCC) represents an evolution from traditional models of provider-focused and patient-focused care that places a strong emphasis on optimal patient communication, patient autonomy, and shared decision-making within care teams. A shift towards PFCC requires participation across all provider groups. Despite the importance of physician buy-in, research examining physicians’ perspectives on PFCC is lacking. We sought to explore oncologists’ familiarity with the principles of PFCC and perceived barriers to implementing principles of PFCC. Methods: In this qualitative exploratory study, we conducted semi-structured interviews with 18 oncologists (8 radiation, 4 medical, 4 surgical, 2 hematologist-oncologists) at a single Canadian academic cancer institution. Interview data were analyzed using coding principles drawn from grounded theory. Constant comparisons were used to identify recurring themes. Results: We identified 3 dominant themes related to physicians’ interpretations of PFCC: 1) Physicians expressed a limited understanding of the formal principles of PFCC, 2) Physicians identified patient autonomy as essential to PFCC and 3) Disparities between patient and physician objectives exist and result in compromises that may affect the quality of PFCC delivered. Oncologists perceived that spending more time with patients improved PFCC, but also recognized that it would leave less time for other necessary activities. Participants also identified a number of ‘system’ barriers to PFCC, including limited staff and clinical space, excessive case load, a lack of physician support and input into operational decisions, and funding constraints. Many felt that PFCC was challenged by inefficiencies in the system of care delivery, and that progress might lie in reorganization to more clearly match health care staff’s roles and responsibilities to their credentials and skills. Conclusions: Advancing PFCC in our institution will require continued education of physicians regarding the principles of PFCC, acknowledgement and preservation of the PFCC behaviors already in practice and creative solutions to address the system issues that may hamper their abilities to enact PFCC.
A physician's practice, attitude and approach for the management of palliative care for cancer.
Authors: Feng Shijian , Zhang Qiongwen , Yu Chunhua , Shi Huashan , Yao Wenxiu , Zhao Yuwei , Wang Yongsheng 
Published: February 2017

112 Background: Pain is the most frequent and persistent symptom experienced by cancer patients. Thus, exploring how to achieve the best outcome of cancer pain management in China is clearly extremely important. Our study focuses on the Chinese physicians' current clinical practice, attitudes, toward and barriers to opioid use, and knowledge of cancer pain management. Methods: A face to face survey include 23 items was designed and conducted to the doctors working with cancer pain managements (oncologists, internists, hematologists, et al) responsible for the care of patients with cancer in 11 tertiary hospitals in China. Descriptive statistics were used to characterize the total sample and for multiple choice questions and each item. Chi-square analysis was used to examine the difference between categorical variables. Results: 500 questionnaires were received out of 550. Most (62.2%) physicians assessed patients’ cancer pain every day, but 85.5% never or occasionally treated patients’ cancer pain together with psychologists. Most respondents appreciated that > 50% of patients with cancer experience severe chronic pain warranting analgesic therapy (73.5%), and that this therapy could control pain adequately in > 50% of patients (77.2%). More than half of physicians indicated that opioid dose titration in patients with poor pain control and assessment of the cause and severity of pain were urgently needed knowledge for cancer pain management. A majority (65.0%) of physicians responded incorrectly (60.0% agreed and 5.0% had no opinion) that they would increase the dosage of a potent opioid and administer it every 4 h as needed (q4h PRN). Inadequate assessment of pain and pain management (63.0%), patients' reluctance to take opioids (62.2%), and inadequate staff knowledge of pain management (61.4%) were the three most frequently barriers to physicians’ pain management. Conclusions: Our results revealed that physician education in cancer pain management in China does not currently provide the necessary levels of knowledge and skills. Therefore, effective strategies and professional education are still needed to encourage physicians’ concern with, experience in, and knowledge of cancer pain management in China.
How do they view us? Oncology providers’ perceptions of early/concurrent palliative care.
Authors: Babu Dilip Sankar , Dionne-Odom J Nicholas , Zubkoff Lisa , Smith Tasha , Bakitas Marie 
Published: February 2017

114 Background: Early integration of palliative care has been increasingly recognized as an important component in the care of cancer patients, including during active anticancer treatment. Yet, palliative and supportive care interventions remain to be well integrated into standard oncology practice. We sought to develop an original survey instrument in order to describe oncology providers’ perceptions of palliative care, particularly when introduced in the early and concurrent setting. Methods: We conducted a systematic review of literature pertaining to perceptions of palliative care and barriers to referral, and extracted survey items where they were found. This pool of questions was narrowed to focus on early/concurrent palliative care, and supplemented with original items. The draft survey was then systematically validated using a standardized scoring system and content-validity approach. Results: Twenty-two studies were reviewed. From an initial pool of fifty items, twenty-nine were selected for the draft survey. The draft was then reviewed by ten oncology providers, who scored each item and provided comments. Conclusions: We have produced a fully validated survey instrument that will be used to characterize oncology providers’ perceptions of early and concurrent palliative care interventions. The validated survey will be administered to oncology clinicians (including nurses, social workers and chaplains) at four academic medical centers at which an early palliative care intervention is currently being implemented. We hope to assess perceptions before and after implementation of the early palliative care intervention.
Development of provincial clinical standards for the province of Ontario.
Authors: Urowitz Sara , Marshall Denise , Myers Jeff , Bryant Deanna 
Published: February 2017

117 Background: The province of Ontario is committed to improving palliative care services. This commitment to change is outlined in The Declaration of Partnership, the provincial roadmap for improving palliative care. To help drive this change in the clinical environment, a Clinical Council for Palliative Care was established to be responsible for providing direction on clinical implications of policy, and advancing clinical improvement in palliative care in Ontario. To this end, Clinical Council has articulated a set of 12 interrelated provincial clinical standards which outline priority areas for clinical change and improvement in the province. Methods: Key stakeholder engagement was undertaken to identify evidence-based, best practices for delivery of palliative services. A consensus process was used to identify the priority set of essential clinical standards for high quality care that is both practical and scalable. Expert working groups were established to refine the standards based on evidence and leading or best practice to the Ontario context. Response was solicited from stakeholders, and qualitative analysis was conducted; standards will be refined based on feedback. Results: Based on the results of the stakeholder engagement, a “Clinical Change Strategy” was identified and a set 12 “clinical imperatives” were identified. Through the consensus process 12 Provincial Clinical Standards were endorsed. Conclusions: Engaging in an evidence informed process with key stakeholders has enabled the creation of a set of 12 interconnected Provincial Clinical Standards for palliative care in Ontario. These standards will help to advance high quality palliative care in the province. The standards represent a population health based strategy for change, which can have a positive impact at the systems level. Stakeholder feedback will result in further refinement of the standards, which will ultimately provide the foundation for standardized approaches for palliative services across Ontario.
Predictors of radiation therapy (RT) use among Medicare patients with metastatic non-small cell lung cancer (NSCLC).
Authors: Kim Miranda , Schrag Deborah , Li Ling , Chen Aileen B. 
Published: February 2017

124 Background: Palliative RT can improve quality of life, but also incurs time and financial costs. We evaluated factors associated with use and intensity of palliative RT for metastatic NSCLC. Methods: Using SEER-Medicare data, we identified patients diagnosed with pathologically confirmed stage IV NSCLC from 2004-2011. Receipt of RT and total fractions in the first RT course was collected. Univariable and multivariable logistic regression were used to identify factors associated with RT receipt and higher intensity RT ( > 10 fractions). Models were adjusted for clustering at the county level. Results: Among 53,371 patients with stage IV NSCLC, 39% (20,937) received palliative RT. Among patients receiving RT, 48% (10,048) received > 10 fractions and only 3.5% (724) received single fraction RT. On multivariable analysis, factors associated with greater RT use included younger age group (overall p < .01), lower Charlson comorbidity score (overall p < .01), female gender (OR 1.1, p < .01), married status (OR 1.1, p < .01), South (OR 1.0) and Midwest (OR 1.1) SEER region vs. Northeast (ref) or West (OR 0.9) (overall p < .01), higher radiation oncologist density tertile (OR 1.1, overall p = .02), hospice use (OR 1.47, p < .01), and chemotherapy use (OR 3.61, p < .01). Among patients treated with RT, predictors for > 10 fractions were older age group (overall p = .03), no hospice use (OR 1.1, p < .01), chemotherapy use (OR 1.9, p < .01) and freestanding vs. hospital-based RT facility (OR 1.66, p < .01). Conclusions: A combination of patient, treatment, and health service factors influenced whether a patient received palliative RT. In contrast, most patient factors (except age) did not influence the decision to treat with higher intensity radiation. The receipt of chemotherapy and treatment at a freestanding RT facility were highly predictive for extended RT fractionation, which may have been partially driven by higher reimbursement rates to freestanding facilities during this period.
Health disparities in advance care planning at a safety-net hospital.
Authors: Levin Elizabeth , Ries Michael , Rubins Jeffrey B , Wiernik Andres 
Published: February 2017

125 Background: Advance health care directives (AHCDs) are recommended by ASCO as a strategy to improve compliance with patient wishes at the end-of-life, thereby facilitating appropriate use of health care resources. We already know too few cancer patients complete AHCDs, but we know less about barriers to their completion. This study assessed the frequency with which AHCDs were completed in different ethnic groups and whether hospice enrollment varied by ethnicity. Methods: Retrospective analysis conducted at Hennepin County Medical Center in Minneapolis, MN with review of the cancer registry data from 2008 to 2013. Data were collected for deceased patients with stage III-IV cancer from the time of diagnosis through death. Demographics, AHCD, hospital deaths, enrollment in hospice, and individual patient data were analyzed using logistic regression, adjusting for both race and language as covariates. Results: From 2008 to 2013, there were 273 patients diagnosed with stage III-IV cancer and followed through death. Fourteen percent of patients were non-English speaking. Thirty-one percent were African American (AA), 4% were Hispanic, and 4% were Asian. Only 21% of patients completed an AHCD during their care, and none were Asian or Hispanic. English speakers were almost five times more likely than non-English speakers to have an AHCD (OR = 4.66, 95% CI = (1.06, 20.46), p = 0.04). Fifty-one percent of English-speaking patients enrolled in hospice compared to 39% of non-English-speaking patients (p = 0.08). Sixty percent of patients with an AHCD enrolled in hospice compared to 46% of those patients without an AHCD (p = 0.10). Forty-three percent of patients with an AHCD died in the hospital, 33% of whom died in an intensive care unit (ICU), versus 46% without an AHCD, 49% of whom died in an ICU. Of patients with advanced cancer, 46% died in the hospital and 21% died in the intensive care unit (ICU). Conclusions: Non-English-speaking patients are far less likely to have an AHCD than English speakers. Some ethnicities in our study had no patients with an AHCD. Since completing an AHCD may increase hospice enrollment and decrease ICU deaths, strategies to promote advance care planning are urgently needed, particularly with non-English speaking patients.
National guidelines for the best practices in palliative and end-of-life care for lesbian, gay, bisexual, and transgender cancer patients and their families.
Authors: Maingi Shail , O'Mahony Sean , Bare Michael G , Margolies Liz , Scout Nfn , Kamen Charles Stewart 
Published: February 2017

126 Background: A growing body of evidence indicates that LGBT communities are disproportionately affected by cancer due to higher rates of traditional risk factors such as tobacco and alcohol, non-inclusion in educational campaigns, and minority stress. Due to the exclusion of sexual orientation and gender identity measures in national oncology databases, there has been difficulty documenting the extent of healthcare disparities that exist for LGBT cancer patients. However, an increasing number of studies describe the experiences of LGBT patients and their families at the end of life. Although societal attitudes and legal protections are shifting, the existing literature clearly indicates that LGBT patients in palliative and end-of-life care settings encounter unique barriers to quality care. For example, LGBT individuals may distrust specific members of palliative care teams, such as a pastor because of past rejections by faith-based communities. Other barriers include high levels of familial rejection, fear of revealing minority status, and a lack of legal protection. Methods: In 2014 and 2015, a CDC-funded multidisciplinary expert panel met to develop the best practices across the cancer care continuum for the LGBT community. The experts drew on available literature and clinical and community experience. They reached a consensus regarding recommendations that were later reviewed using a process that elicited comments from providers, patients, and community and national organizations. Results: Recommendations were made in 7 domains: 1) cancer prevention, 2) cancer screening, 3) diagnosis, 4) treatment, 5) survivorship, 6) palliative and end-of-life care, and 7) public health. Here we report the panel’s recommendations for improving palliative and end-of-life care for LGBT cancer patients. Conclusions: The barriers for LGBT cancer patients to access quality palliative and end-of-life care exist, and the subsequent healthcare disparities are often invisible to healthcare providers. Implementation of these national recommendations will help eliminate the disparities that LGBT patients and their families experience when facing cancer.
An interdisciplinary early simultaneous palliative approach in advanced lung cancer (a-LC): Preliminary data in outpatient setting experience.
Authors: Catino Annamaria , Aloe Ferruccio , Piccininno Maria Elvira , Daniele Antonella , Misino Andrea , Ricci Donata , Damiani Basilio , Cormio Claudia , Logroscino Antonio , Galetta Domenico 
Published: February 2017

138 Background: To integrate Simultaneous Palliative Care with standard cancer care is a growing-interest concept; hence, a global patient-centered care rather than disease-directed intervention is a major issue in advanced Lung Cancer (a-LC). These patients are often characterized by high tumor burden and comorbidities related to smoking history and elderly; furthermore, malnutrition could contribute to worse outcome. Some landmark experiences have demonstrated that a-LC patients benefit from simultaneous palliative care in early phase of treatment. The initial results of a pilot experience on early simultaneous interdisciplinary palliative approach in a-LC patients, referring to the Thoracic Oncology outpatient department of a Clinical Cancer Center, are reported. Methods: From October 2014 to May 2015, 35 patients with stage IV disease, receiving first-line therapy, were accrued. The team includes medical oncologists, a palliative care specialist, a psychologist, a nutritional expert and a research nurse. The baseline assessment comprised the disease status and comorbidities, psychosocial distress, pain and Mini-nutritional assessment (MNA). Smoking habits were recorded and information about smoking cessation programs was provided. A survey about the grade of satisfaction of patients during this multimodal approach was conducted. Results: The main patients’ characteristics are shown in Table.18/35 patients required pain treatment reassessment, while 13/35 patients had severe malnutrition. The most frequent symptoms were pain (24/35), severe psychological distress (24/35), asthenia (23/35) and anorexia (20/35). Conclusions: This approach is suggested due to multiple unmet needs of these patients; these preliminary data confirm that an interdisciplinary early palliative care is feasible in an outpatient setting with good compliance and satisfaction of patients as well as of caregivers. [Table: see text]
The utilization of chemotherapy and radiation at the end of life in individuals with metastatic non-small cell lung cancer.
Authors: Stavas Mark J. , Martin Sara F. , Phillips Sharon E. , Perkins Stephanie Mabry , Shinohara Eric T. 
Published: February 2017

143 Background: Advancements in the diagnosis and treatment of metastatic non-small cell lung cancer (NSCLC) have contributed to improved quality of life and survival. However, these successes are matched with rising healthcare costs and a growing debate over the appropriate utilization of medical resources near the end of life. To date, the majority of utilization studies report outcomes based on single institution or Medicare models. This may lead to significant bias due to individual physician preferences, narrow age groups or single payer systems. The purpose of this study is to analyze the broader trends and variables impacting the use of chemotherapy (CHT) and radiation (XRT) in the final months of life. Methods: The Florida Cancer Data System (FCDS) was used to evaluate patients with Stage IV (M1) NCLC from 1995 to 2010. Logistic Regression was used to determine the association between insurance types, census-based socioeconomic status (SES) and demographic variables with XRT received or CHT received. Results: 48,858 patients were identified within the FCDS and eligible for this study. The median age was 69 years. The median survival was 4.8 months. The overall use of XRT decreased between 1995 and 2010 from 52% to 37%, while the use of CHT increased from 35% to 49%. The utilization of treatment during the final 60, 30 and 14 days of death was 28%, 13% and 5% respectively for XRT, and 18%, 8% and 4% for CHT. Neither insurance status (OR, 0.852; 95% CI, 0.721 -1.174) nor poverty status (OR, 1.026; 95% CI, 0.950 -1.109) was predictive for XRT received. Those classified as low SES (OR, 0.685, 95% CI, 0.633-0.741) or not insured (OR, 0.678, 95% CI, 0.572-0.804) were less likely to receive CHT. Older-unmarried-females were less likely to receive CHT and XRT compared to their younger-married-male counterparts. Conclusions: When examining a broader demographic and insurance mix, the utilization of XRT and CHT in the final 30 and 14 days of death remain low at 13% and 5% for radiation and 8% and 4% for chemotherapy consistent with previously reported studies. Younger-married-males were more likely to receive palliative treatments. Insurance and SES did not influence the delivery of XRT while they did impact the use of CHT.
Multidisciplinary cancer conferences as a forum for early identification of patients who can benefit from palliative care.
Authors: Wright Frances Catriona , Johal Hardeep , MacKinnon Marnie , Arthurs Erin 
Published: February 2017

148 Background: Introducing palliative care early in the cancer journey results in a better quality of life, less aggressive care and longer survival compared to patients receiving standard care. The INTEGRATE Project goal is to identify and manage patients who can benefit from palliative care using the UK Gold Standards Framework Surprise Question (would you be surprised if this person died within the next year?). Multidisciplinary cancer conferences (MCCs) are scheduled meetings for oncology teams to prospectively discuss patient diagnostic tests and treatment options, which were leveraged for the INTEGRATE Project. Methods: A pilot study to test the efficacy of the Surprise Question at MCCs and implementation of a palliative model of care has been implemented in 3 academic and 1 non-academic cancer centres. A survey was completed to identify provider comfort levels in providing palliative care. All sites completed Pallium Canada’s LEAP Onco module, which equips providers with skills to provide primary level palliative care. Patients identified at MCCs received advance care planning, symptom management, referrals and standardized reporting to primary care. Results: Four disease sites (Lung, GI, CNS and Head & Neck) are participating. A baseline survey showed over 50% of providers had no training in palliative care. 161 providers participated in LEAP Onco. Implementation of the Surprise Question at MCCs began in February 2015. Two months of implementation identified 39 patients at the CNS, Lung and GI disease sites out of 108 of patients reviewed. At the CNS MCC, 100% glioblastoma patients were identified. The Lung and GI disease sites had lower identification rates (27% and 10%, respectively). Identified patients will have their healthcare utilization (referrals to community providers, billing patterns, ER visits) analyzed to determine impact of this project. Implementation continues until 2016. Conclusions: MCCs appear to be an excellent forum for identifying patients who can benefit from a palliative approach to care within the CNS, Lung and GI site groups. Further data is being collected to inform provincial recommendations for broader implementation of palliative care in Ontario.