Radiation Oncologists' Role in End-of-Life Care: A Perspective From Medical Oncologists.

Autor:	Gross JP; Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Kruser JM; Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Moran MR; Department of Medical Social Sciences, and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Kaiser K; Department of Medical Social Sciences, and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Szmuilowicz E; Division of Hospital Medicine (Palliative Care), Northwestern University Feinberg School of Medicine, Chicago, Illinois., Kircher SM; Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Kruser TJ; Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: tkruser@nm.org.
Jazyk:	angličtina
Zdroj:	Practical radiation oncology [Pract Radiat Oncol] 2019 Sep - Oct; Vol. 9 (5), pp. 362-370. Date of Electronic Publication: 2019 Jun 12.
DOI:	10.1016/j.prro.2019.04.001
Abstrakt:	Purpose: Multidisciplinary communication and collaboration are key to planning and delivering end-of-life care for patients with advanced and metastatic cancer. We sought to characterize medical oncologists' perspectives on the role of radiation oncologists in end-of-life care. Materials and Methods: A sample of US medical oncologists was recruited using snowball sampling methods. Audio recordings of 4 professionally moderated focus groups were transcribed. Investigators from diverse backgrounds (medical oncology, radiation oncology, critical care medicine, palliative care, and public health) independently reviewed each transcript. Qualitative content analysis was used to create consensus codes that were applied to subsequent focus group transcripts in an iterative process. Results: Medical oncologists expressed complex views regarding the role of radiation oncologists in end-of-life care. Identified themes included the limited role of radiation oncologists, territorial concerns, capability, and desire of radiation oncologists in this realm, and the need for communication between providers. Radiation oncologists were compared with surgeons, whose interaction with patients ceased after their service had been performed. In this regard, control of palliative care referral or end-of-life care discussions was thought to be in the territory of medical oncologists who had longitudinal relationships with patients from diagnosis. Medical oncologists were concerned about the capability of radiation oncologists to accurately prognosticate, and stated radiation oncologists lacked knowledge of subsequent lines of systemic therapy available to patients. Radiation oncologists' fear of upsetting medical oncologists was thought to be justified if they engaged in end-of-life care planning without direct permission from the referring medical oncologist. Conclusions: Participation of radiation oncologists in end-of-life care planning was viewed with skepticism by medical oncologists. Radiation oncologists should focus on increasing open communication and teamwork with medical oncologists and demonstrate their ability to prognosticate and counsel patients regarding end-of-life care decisions. (Copyright © 2019 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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