Too close for comfort? Attitudes of gynecologic oncologists toward caring for dying patients

Abstract

Objectives: Gynecologic oncologists are frequently intimately involved in end of life care for their patients. The primary objective of this study was to assess the attitudes of gynecologic oncology providers toward palliative care for advanced cancer patients. Methods: SGO members categorized as gynecologic oncologists or medical oncologists were surveyed via an anonymous RedCap online survey. The survey consisted of basic demographic information and a survey regarding attitudes of medical oncologists toward palliative care for patients with advanced and incurable cancer. Descriptive statistics were calculated. Associations between provider sociodemographic characteristics and responses were analyzed using linear regression. Results: 1200 members received the survey and 108 (9%) completed the survey. The majority of respondents were female (69.4%) and White (82.4%). Most described their practice as academic (64.8%) and in an urban environment (71.3%). The majority (95.4%) had palliative care providers at their institution and stated they were often directly involved with discussing end of life care preferences with their patients (88%). The majority believed that oncologists should coordinate the care of cancer patients at all stages of disease, including end of life care (66%). Most believed that all advanced cancer patients should receive concurrent palliative care along with anti-tumor therapies (81%). The majority derived satisfaction from their work managing patients with advanced cancer (83%). Twenty percent stated that managing patients with advanced cancer and dying patients depresses them. Twenty-seven percent stated they felt emotionally burned out by having to deal with too many deaths. There were no significant associations between sociodemographic characteristics and responses. Conclusions: The majority of gynecologic oncologists believe that palliative care should occur in conjunction with anti-tumor therapies. Most gynecologic oncologists are involved in the care of their patients at the end of life and derive satisfaction from their work. This close connection with patients as they transition to the end of life may take a toll on providers. Nearly a third of respondents felt emotionally burned out by managing death. One in five surveyed felt depressed by end of life care work.