Clinician Perspectives on Palliative Care for People with Hepatocellular Carcinoma: Facilitators of and Barriers to Referral
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participant Recruitment
2.3. Data Collection
2.4. Data Analysis
3. Results
3.1. Facilitators of Palliative Care Referral
3.1.1. Helpfulness at Times of Transition
3.1.2. Helpful for Management of Certain Symptoms
3.1.3. Provision of Psychosocial Support
3.1.4. Positive Experiences with Referrals
3.2. Barriers to Palliative Care Referral
3.2.1. Feasibility Concerns
3.2.2. Lack of Information
3.2.3. Lack of Symptoms Requiring Outside Referral
3.2.4. Concerns about Palliative Care
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Factors That Promote Palliative Care Referral—Facilitators | Examples | Actions to Address Said Factor |
---|---|---|
Helpfulness at times of transition | Palliative care referral may occur in the setting of transplant list removal or initiation of systemic therapy; participants emphasized prognostic uncertainty | Evaluation and testing of automatic palliative care assessment at transition points Development of tailored communication interventions (e.g., frameworks to express prognostic uncertainty) |
Help with symptom management | Palliative care can help manage cancer-related pain requiring opioids, insomnia, and anxiety | Use of patient-reported outcome measures to trigger palliative care referral |
Provision of additional psychosocial support | Provision of additional support particularly in the setting of removal from transplant list | Proactive identification of people in need of additional psychosocial support, coordination with existing social work, and chaplaincy services |
Positive experiences | Witnessing helpfulness of palliative care in practice | Development of inter-departmental feedback mechanisms for quality improvement |
Factors That Inhibit Palliative Care Referral—Barriers | Examples | Actions to Address Said Factor |
---|---|---|
Feasibility concerns | Lack of palliative care availability Adding additional visit to busy patient schedule | Development of co-located or embedded palliative care models; use of telehealth |
Lack of information | Unclear referral criteria Not sure what services are offered by palliative care | Development of referral criteria and dissemination to HCC-treating clinicians |
Lack of symptoms that require referral | Many symptoms managed primarily by liver specialists Pain not very prevalent until very advanced disease | Development of primary palliative care interventions, patient and family caregiver education |
Concerns about palliative care | Worry about patient perception of ambivalence, doubt, and lost hope Worry about introducing new team | Broad messaging about the nature and benefits of early palliative care; normalize early identification of surrogate decision makers; consideration of language used to describe palliative services |
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Woodrell, C.D.; Mulholland, C.N.; Goldstein, N.E.; Hutchinson, C.L.; Schiano, T.D.; Hansen, L. Clinician Perspectives on Palliative Care for People with Hepatocellular Carcinoma: Facilitators of and Barriers to Referral. Cancers 2023, 15, 3617. https://doi.org/10.3390/cancers15143617
Woodrell CD, Mulholland CN, Goldstein NE, Hutchinson CL, Schiano TD, Hansen L. Clinician Perspectives on Palliative Care for People with Hepatocellular Carcinoma: Facilitators of and Barriers to Referral. Cancers. 2023; 15(14):3617. https://doi.org/10.3390/cancers15143617
Chicago/Turabian StyleWoodrell, Christopher D., Christie N. Mulholland, Nathan E. Goldstein, Carole L. Hutchinson, Thomas D. Schiano, and Lissi Hansen. 2023. "Clinician Perspectives on Palliative Care for People with Hepatocellular Carcinoma: Facilitators of and Barriers to Referral" Cancers 15, no. 14: 3617. https://doi.org/10.3390/cancers15143617