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McGill Family Medicine Studies Online, 13: e18

Page history last edited by reem.elsherif@mail.mcgill.ca 4 years, 7 months ago

Stoddart, Caitlin (2018). The gatekeepers of palliative care: A systematic mixed studies review of oncologists' perceptions and attitudes towards palliative care for advanced cancer patients. McGill Family Medicine Studies Online, 13: e18


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Background: Early palliative care has been shown to optimize a variety of different aspects of cancer care including symptom management, psychosocial support, spiritual care and decision-making. Despite these benefits and the increasing availability of palliative care services, the majority of cancer patients are only referred to palliative care in the late, terminal stages of disease. As the gatekeepers of palliative care, oncologists can offer a wealth of insight into why cancer patients are not being referred as early and as often as they should.


Objectives: The main purpose of this thesis is to explore oncologists' perceptions and attitudes toward palliative care in order to better understand the physician-level barriers to early palliative care referral.


Methods: This thesis contains of two related manuscripts. The first manuscript consists of a systematic mixed studies review and narrative synthesis of the current literature investigating oncologists' perceptions and attitudes toward palliative care for cancer patients. The second manuscript expands on the first manuscript by examining oncologist-driven models of palliative care referral from an ethical perspective.


Results: Twenty-one studies met the inclusion criteria for the systematic review. Themes describing oncologists' perceptions of palliative care include: 1) the value of palliative care, 2) the timing of palliative care referral, 3) the role of the palliative care provider, 4) the coordination of care, 5) the philosophy of care and 6) the impact of palliative care referral on the patient. The ethical analysis found that, owing to oncologists' heterogeneous perceptions of palliative care, the current oncologist-driven models of palliative care referral are unethical and need to be improved.


Conclusions: The delays in referral to palliative care are likely due to the conflicting professional cultures of oncology and palliative care, as well as a lack of provider knowledge about the appropriate use and timing of palliative care referral. Understanding these physician-level barriers to early referral is crucial to inform the development of strategies to increase collaboration between oncology and palliative care teams and improve the early provision of palliative care for advanced cancer patients.


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