Attitudes among Physicians Regarding Palliative and Hospice Care in an Oncology Center: Results of a Physician Survey (705)

Abstract

Objectives 1. Identify physicians’ attitudes towards palliative and hospice care. 2. Identify possible strategies to change attitudes. I. Background. Palliative care is gaining increasing recognition and physicians’ attitudes are changing. II. Research Objectives. To identify physicians’ attitudes towards palliative and hospice care. To identify possible strategies to change attitudes. III. Methods. Survey was sent to 132 physicians. IV. Results. Response rate was 48%; 31.3% pediatricians, 40.6% internists, 15.6% surgeons, and 6.3% radiotherapists. 56.3% were residents, 12.5% fellows, and 31.3% consultants. Experience ranged from 0.17e35 years (median, 5 years). A total of 95.3% reported no training in palliative care. For 81.3%, work demands made it difficult to provide palliative care. All considered it important to provide pain and symptom control. A total of 71.9% considered it important to support patients/families through counseling and spiritual and bereavement care and 76.6% to manage psychiatric/psychological disorders. A total of 47.1% considered it appropriate to refer patients as soon as diagnosed with a life threatening illness, 32.9% only after curative efforts were exhausted, and none to refer patients in the last days of life. A total of 95.3% will use palliative care services for pain management, 84.4% for psychosocial and psychiatric support, 82.8% for symptom management, 79.7% for assistance in obtaining DNR, 75% to put a comprehensive care plan for comfort care and assist with referrals to hospice/home care, and 67.2% to resolve complicated ethical issues. A total of 45.3% don’t know about hospice/ home care, 46.9% don’t feel comfortable breaking bad news, 59.4% believe that patients/families are not receptive to hospice and other services, 21.9% think that their patients do not meet hospice requirements or do not have insurance coverage for hospice. 37.5% think that the institution lacks comfortable settings for dying patients/families. V. Conclusion. Physicians considered palliative care important. Lack of education and understanding of palliative and hospice care affects physicians’ attitudes. VI. Implications for Research, Policy, or Practice. Educational programs to change physicians’ attitude towards palliative care, training in communication skills, and policies may be useful strategies.