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J Pain Symptom Manage · Nov 2021
Perceptions of Hematology Among Palliative Care Physicians: Results of a Nationwide Survey.
- Wil L Santivasi, Daniel S Childs, Kelly L Wu, Daniel K Partain, Mark R Litzow, Thomas W LeBlanc, and Jacob J Strand.
- Center for Palliative Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States. Electronic address: santivasi.wil@mayo.edu.
- J Pain Symptom Manage. 2021 Nov 1; 62 (5): 949-959.
ContextPalliative care integration for patients with hematologic diseases has lagged behind solid-organ malignancies. Previous work has characterized hematologist perspectives, but less is known about palliative care physician views of this phenomenon.ObjectivesTo examine palliative care physician attitudes and beliefs regarding hematologic diseases, patient care, and collaboration.MethodsA 44-item survey containing Likert and free-response items was mailed to 1000 AAHPM physician members. Sections explored respondent comfort with specific diagnoses, palliative care integration, relationships with hematologists, and hematology-specific patient care. Logistic regression models with generalized estimating equations were used to compare parallel Likert responses. Free responses were analyzed using thematic analysis.ResultsThe response rate was 55.5%. Respondents reported comfort managing symptoms in leukemia (84.0%), lymphoma (92.1%), multiple myeloma (92.9%), and following hematopoietic stem cell transplant (51.6%). Fewer expressed comfort with understanding disease trajectory (64.9%, 75.7%, 78.5%, and 35.4%) and discussing prognosis (71.0%, 82.6%, 81.6%, and 40.6%). 97.6% of respondents disagreed that palliative care and hematology are incompatible. 50.6% felt that palliative care physicians' limited hematology-specific knowledge hinders collaboration. 89.4% felt that relapse should trigger referral. 80.0% felt that hospice referrals occurred late. In exploring perceptions of hematology-palliative care relationships, three themes were identified: misperceptions of palliative care, desire for integration, and lacking a shared model of understanding.ConclusionThese data inform efforts to integrate palliative care into hematologic care at large, echoing previous studies of hematologist perspectives. Palliative care physicians express enthusiasm for caring for these patients, desire for improved understanding of palliative care, and ongoing opportunities to improve hematology-specific knowledge and skills.Copyright © 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
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