Medical oncologists' perception of palliative care programs and the impact of name change to supportive care on communication with patients during the referral process. A qualitative study.

OBJECTIVE: In a simultaneous care model, patients have concurrent access to both cancer-directed therapies and palliative care. As oncologists play a critical role in determining the need/timing of referral to palliative care programs, their understanding of the service and ability to communicate this with patients is of paramount importance. Our study aimed to examine oncologists' perceptions of the supportive care program at M.D. Anderson Cancer Center, and to determine whether renaming "palliative care" to "supportive care" influenced communication regarding referrals. METHOD: This qualitative study used semi-directed interviews, and we analyzed data using grounded theory and qualitative methods. RESULTS: We interviewed 17 oncologists. Supportive care was perceived as an important time-saving application, and symptom control, transitioning to end-of-life care, family counseling, and improving patients' ability to tolerate cancer therapies were cited as important functions. Although most claimed that early referrals to the service are preferable, oncologists identified several challenges, related to the timing and communication with patients regarding the referral, as well as with the supportive care team after the referral was made. Whereas oncologists stated that the name change had no impact on their referral patterns, the majority supported it, as they perceived their patients preferred it. SIGNIFICANCE OF RESULTS: Although the majority of oncologists favorably viewed supportive care, communication barriers were identified, which need further confirmation. Simultaneous care models that effectively incorporate palliative care with cancer treatments need further development.

Stress variances among informal hospice caregivers.

Care interventions are not routinely provided for hospice caregivers, despite widespread documentation of the burden and toll of the caregiving experience. Assessing caregivers for team interventions (ACT) proposes that holistic patient and family care includes ongoing caregiver needs assessment of primary, secondary, and intrapsychic stressors. In this study, our goal was to describe the variance in stressors for caregivers to establish evidence for the ACT theoretical framework. We used secondary interview data from a randomized controlled trial to analyze hospice caregiver discussions about concerns. We found variances in stress types, suggesting that caregiver interventions should range from knowledge and skill building to cognitive-behavioral interventions that aid in coping. Family members who assume the role of primary caregiver for a dying loved one need to be routinely assessed by hospice providers for customized interventions.

Reciprocal suffering: caregiver concerns during hospice care.

CONTEXT: For many hospice caregivers, the constancy and difficulty of caregiving impact their physical quality of life and cause depression, psychological distress, guilt, loneliness, and restrictions on social activities. OBJECTIVES: Deviating from traditional unidimensional research on hospice caregivers, this study explored the transactional nature of reciprocal suffering by examining caregiver concerns through four dimensions: physical, psychological, social, and spiritual. METHODS: Researchers analyzed audiotapes of intervention discussions between hospice caregivers and research social workers. RESULTS: Results indicated that, of the 125 pain talk utterances, most referenced psychological concern (49%), followed by physical (28%), social (22%), and spiritual (2%) concerns. Reflections on concerns revealed a global perspective of caregiving, which highlighted the patient's needs juxtaposed to the caregiver's recognized limitations. CONCLUSION: By examining the reciprocal nature of suffering for caregivers, this study reinforced the need for assessing caregivers in hospice care, with specific emphasis on the importance of providing caregiver education on pain management.

The role of the hospice medical director as observed in interdisciplinary team case reviews.

BACKGROUND: The purpose of this study was to observe the roles played by six hospice medical directors from two hospice programs during interdisciplinary team case reviews. METHODS: The study analyzed videotapes of case reviews in two hospice agencies over a two year period. The results indicate that the roles and levels of participation vary. Medical Directors were observed reviewing and assisting with care plans, acting as a liaison with primary physicians, educating staff, consulting with attending physicians, participating in quality assurance activities, and dealing with budget issues. RESULTS: Medical Directors did not make home visits or assume the role of attending physician during the observation period. CONCLUSIONS: The study demonstrates variance in roles among medical directors and raises new questions for future research.

Inviting the absent members: examining how caregivers' participation affects hospice team communication.

This paper is a secondary observation of a larger pilot study. The Assessing Caregivers for Team Intervention via Video Encounters intervention project enabled caregiver participation in hospice interdisciplinary team meetings. This paper used the team observation scale to assess the impact of caregiver involvement on team structure, process, and outcome. Comparisons were made between traditional team meetings and the team meetings that involved caregivers by using videotapes of both. Analysis found that team meetings with participating caregivers had better team outcomes, with more patient-centered goals, increased discussion of biopsychosocial problems, and the development of interdisciplinary care plans occurring more often than in the traditional hospice team meetings. Findings from this study show benefits for inclusion of caregivers in hospice team meetings.