Referral practices of pediatric oncologists to specialized palliative care

Abstract

The aims of this study are to describe the attitudes and referral practices of pediatric oncologists (POs) to specialized palliative care (SPC), and to compare them with those of adult oncologists (AOs). Canadian members of the American Society of Pediatric Hematology/Oncology (ASPHO), Canadian Association of Medical Oncologists (CAMO), Canadian Association of Radiation Oncologists (CARO), and the Canadian Society of Surgical Oncology (CSSO) participated in an anonymous survey assessing SPC referral practices. The response rate was 70% (646/921), 52% (43/82) for ASPHO members; 5 CARO members self-identified as POs, for a total of 48 POs and 595 AOs. Ninety-six percent of POs had access to inpatient SPC consultation services(vs. 48 % AOs), 31% to a PCU (vs. 82% AOs), and 27% to an outpatient SPC clinic (vs. 73% AOs). POs more often stated their SPC services accepted patients on chemotherapy than AOs (64 vs. 37%, p = 0.0004). POs were less likely to refer only after chemotherapy had been stopped (13 vs. 29% for AOs) and more likely to state that ideally referral should occur at the diagnosis of cancer/incurable cancer (73 vs. 43%). POs were more likely to agree they would refer earlier if palliative care were renamed "supportive care" (58 vs. 33%, p < 0.0001), that palliative care adds too many providers (17 vs. 7%, p = 0.002), and that palliative care was perceived negatively by their patients (60 vs. 43%, p = 0.02). Although POs acknowledge the importance of early referral to SPC for children with cancer, there remain resource and attitudinal barriers to overcome in this regard.