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It is probably important to seek out specialists in Palliative care if possible based on this article

Oncologists Inadequately Prepared to Provide Palliative Care: Survey

By Karla Gale

NEW YORK (Reuters Health) Dec 19 - The wide gulf between oncologists' positive attitudes toward palliative care and the actual delivery of that care suggests that educational initiatives and infrastructure changes are needed to increase specialists' expertise and participation in comprehensive end-of-life services, according to a new survey.

The European Society of Medical Oncology (ESMO) Supportive and Palliative Care Taskforce surveyed the ESMO membership to evaluate their involvement in and attitudes toward these issues. A total of 895 members completed and returned the questionnaires, and responses are summarized in the December 1st issue of Cancer.

"Overwhelmingly, we found that most oncologists pay lip service to the fact that [palliative care] is important, but there is a big gap for many people between what they say and what they do," lead author Dr. Nathan I. Cherny told Reuters Health. Dr. Cherny, a member of the Task Force, is on faculty at Shaare Zedek Medical Center in Jerusalem.

For example, about 80% of patients develop confusion in the days to weeks before death, he noted, but only 12% of oncologists commonly manage delirium. "This is a striking indicator of how far removed they are from day-to-day issues for many patients in end-of-life care," Dr. Cherny said.

"Part of the problem is that most oncologists have never been effectively trained in palliative care," he added. Because of the cultural focus on issues surrounding disease modification, "physicians have been acculturated to believe this isn't really medicine, that it is not really important."

Tabulation of survey responses revealed that more than 75% of ESMO members believe that patients should receive palliative care even while anticancer treatment continues, that they should be coordinating that care, and that they should be reading material related to the palliative care of advanced cancer.

"But we were struck by finding that 20% of oncologist said, not only do they not do palliative care, they don't even refer patients to others" who can deliver such care. He believes that they are "so cognitively and emotionally unprepared for the task that they choose to avoid issue altogether."

The ESMO task force recommends that the responsibility to provide palliative care be reinforced by "care pathways and strict infrastructural guidelines." Such measures could include routine screening of patients for adequate symptom control and distress. "As soon as problems are identified, an automatic referral to palliative care should be generated."

"By making this an automatic part of process, you can avoid patients falling between the cracks," Dr. Cherny concluded.

Cancer 2003;98:2502-2510.

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When I volunteered on a hospice board one of the problems was that physicians would wait until the very last minute to refer a patient to hospice. Sometimes they would only be in hospice care a few hours before death. Hospice is working hard on physicians to get them to refer patients much sooner.

Interesting article.

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I thought that in order to use Hospice you couldn't actively seek treatment. That is what we were told. However, there was a program by Hospice called "In Transition" where you could still seek treatment but you weren't quite to the point of using Hospice just for pallative care.

I should find out. How was Hospice when you were on the board?

The article that John sent upsets me because although my mother was not one that fell between the cracks for pallative care, I know others may have. That is why it is so important for a family member to be there every step of the way to make sure they don't suffer any more than they have to.


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I don't know a whole lot about the requirements for hospice but I remember that the diagnosis had to be terminal with death expected within a certain time frame (can't remember how long).

Before I left the hospice a lot was being done on pallative care education etc. with the public. It was a great organization and I was sorry to leave but I had to give up things when John was diagnosed.

I am sorry about your mom Kim. All my best~


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Medicare requires that the person be terminal and expected not to live more than 6 months. However, if the person lives longer, hospice benefits continue. Late referral to hospice, poor physician knowledge of symptom management, and underutilization by non-Whites are all known problems in hospices. There is, thank heaven, some work being done to correct these problems; a solution can't come soon enough.

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