BOSTON —There are several barriers to palliative care, according to recent study results, including that parents may perceive that palliative care does not have a curative intent.
Presenting here at the 2012 Pediatric Academic Societies Annual Meeting, Jeffrey Meyrowitz, MD, along with Todd Dalberg, DO, and colleagues from the Oregon Health and Science University, said barriers to palliative care have never been formally investigated in the field of pediatric oncology.
“Prior studies have shown that common barriers to physicians utilizing palliative care revolve around uncertain prognosis and family preparedness. However, prior literature has shown that prognostic disclosure is not necessarily related to diminished parental hope,” Meyrowitz told Healio.com. “Unfortunately, formal studies looking at barriers to early integration of a pediatric palliative care in oncology patients during up-front diagnoses are very limited.”
The researchers recruited pediatric oncology providers to take part in four focus groups. Each group, containing four to 15 pediatric oncology providers, was subdivided into physicians, nurse practitioners, nurses and social workers, and presented with a proposal for early integration of a pediatric palliative care team. Four independent coders categorized data into themes using crystallization techniques and comparative analysis. Researchers used a consensus approach to arrive at the final themes.
The findings demonstrated several barriers to palliative care, including:
- Physicians are concerned about the overlapping content with a strong desire to control all aspects of patient care.
- Concerns that palliative care does not include curative intent and will send the wrong message to a family dealing with a life-threatening illness.
- Physicians have difficulty maintaining objectivity when dealing with their own patients, as the hope for cure can sometimes influence judgment.
- Physicians equate a patient’s death with personal failure.
Additional barriers associated with palliative care discovered by the focus groups included timing of consultation with respect to parental anxiety and limiting eligibility criteria to patients with the highest disease risk. Identified facilitators included piloting this concept with the eventual goal of conducting a randomized control trial, along with continued education focusing on providers as well as patients and families.
Meyrowitz said the most important aspect of his study illustrated the advantages of palliative care. “We need to address these barriers and focus on educating providers, and if we can establish early palliative care as a viable option, it could be a great benefit for patients.”
For more information:
- Meyrowitz J. #3854.702. Presented at: the 2012 Pediatric Academic Societies Annual Meeting; April 28-May 1, 2012; Boston.
Disclosure: Dr. Meyrowitz reports no relevant financial disclosures.