Supportive versus palliative care: What’s in a name? A survey of medical oncologists and mid-level providers

Abstract

9637 Background: Palliative Care (PC) has been progressively adopted by American cancer centers, however, referrals to PC continue to occur late in the trajectory of illness. We hypothesize that the perceived association between the name PC and hospice is a barrier to early patient (pt) referral. The objectives of this study were to determine the perception of the impact of the name PC as compared to supportive care (SC) on pt referral and to determine whether there is an association between demographic factors and the perceptions of the two names by medical oncologists (MO) and their midlevel providers (MLP) (Advance Practice Nurses and Physician Assistants) in a comprehensive cancer center. Methods: We conducted a survey among a random sample of 100 MOs and 100 MLPs. We collected information on demographics, previous experience in palliative care, and attitudes and beliefs towards the impact of the name PC as compared to SC on patient referral. Results: 140/200 (70%) participants responded (74 MLPs and 66 MOs). Median age was 43 (34.5–50) and there were 83/140 (60%) females. MLPs and MOs agreed in their responses to most of the items. Table 1 summarizes the differences in perception of the two names divided by MO and MLP status. There were no significant associations between the perception of the two names and age (p=0.82), gender (p=0.35), or prior training in PC (p>0.99). Conclusions: The name PC was perceived by MOs and MLPs as more distressing and reducing hope to pts and families. MOs and MLPs significantly prefer the name SC and are more likely to refer pts on active primary (79 vs. 45%, p<0.0001) and advanced cancer (89 vs. 69%, p< 0.0001) treatments to a service named SC. Question PC (%) SC (%) *P MLP MO ALL* N=140 MLP MO ALL* N=140 I prefer this service name 11 (15) 16 (24) 27 (19) 49 (66) 31(47) 80 (57) <0.0001 I would use this service: For pts receiving active primary treatment 32 (45) 29 (44) 61 (45)** 61(84) 50 (76) 111(79) <0.0001 For pts receiving treatment for advanced cancer 53 (72) 43 (65) 96 (69)** 69 (93) 56 (85) 125(89) <0.0001 For pts in transition to end of life 63 (88) 64 (97) 127 (92)** 67 (93) 59 (89) 126 (91) 0.8296 This name causes distress to pts/families 20 (27) 26 (41) 46 (33) 3 (4) 2 (3) 5 (3) <0.0001 This name is a barrier for me to refer pts 20 (27) 12 (18) 32 (23) 5 (7) 4 (6) 9 (6) <0.0001 This name can decrease hope in pts/ families 30 (41) 31 (48) 61 (44) 10 (14) 5 (8) 15 (11) <0.0001 ** p<0.0001 No significant financial relationships to disclose.