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Palliative medicine integration in the USA: cancer centre executives’ attitudes
  1. Joseph Chen1,
  2. Allison de la Rosa1,
  3. Dejian Lai2,
  4. Rony Dev1,
  5. Frances Lee Revere3,
  6. David Lairson3,
  7. Paige Wermuth3,
  8. Eduardo Bruera1 and
  9. David Hui1
  1. 1 Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2 Department of Biostatistics and Data Science, UTHealth School of Public Health, Houston, Texas, USA
  3. 3 Department of Management, Policy, and Community Health, UTHealth School of Public Health, Houston, Texas, USA
  1. Correspondence to Dr David Hui; dhui{at}


Objectives To compare cancer centre (CC) executives’ attitudes towards palliative care between National Cancer Institute-designated CCs (NCI-CCs) and non-NCI-designated CCs (non-NCI-CCs) in 2018 and to examine the changes in attitudes and beliefs between 2009 and 2018.

Methods CC chief executives at all NCI-CCs and a random sample of non-NCI-CCs were surveyed from April to August 2018. Twelve questions examined the executives’ attitudes towards palliative care integration, perceived barriers and self-assessments. The primary outcome was agreement on the statement ‘a stronger integration of palliative care services into oncology practice will benefit patients at my institution.’ Survey findings from 2018 were compared with data from 2009 to examine changes in attitudes.

Results 52 of 77 (68%) NCI-CCs and 88 of 126 (70%) non-NCI-CCs responded to the survey. A vast majority of executives at NCI-CCs and non-NCI-CCs endorsed palliative care integration (89.7% vs 90.0%; p>0.999). NCI-CCs were more likely to endorse increasing funding for palliative care (52.5% vs 23.1%; p=0.01) and hiring physician specialists (70.0% vs 37.5%; p=0.004) than non-NCI-CCs. The top three perceived barriers among NCI-CCs and non-NCI-CCs were limited institutional budgets (57.9% vs 59.0%; p=0.92), poor reimbursements (55.3% vs 43.6%; p=0.31), and lack of adequately trained palliative care physicians and nurses (52.6% vs 43.6%; p=0.43). Both NCI-CCs and non-NCI-CCs favourably rated their palliative care services (89.7% vs 71.8%; p=0.04) with no major changes since 2009.

Conclusion CC executives endorse integration of palliative care, with greater willingness to invest in palliative care among NCI-CCs. Resource limitation continues to be a major barrier.

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  • Contributors Conceptualisation—JC, DH and EB. Data curation—JC, DH and AdlR. Formal analysis—JC. Funding acquisition—DH. Investigation—JC and DH. Methodology—JC and DH. Project administration—DH and AdlR. Resources—DH. Software—JC. Supervision—DH. Visualisation—JC. Writing, original draft—JC and DH. Writing, review and editing—JC, DH, DL, AdlR, RD, FLR, DL, PW and EB.

  • Funding This research was partially funded by a National Institutes of Health Cancer Centre Support Grant (P30CA016672). DH received grants from the National Institutes of Health/National Cancer Institute (R01CA214960-01A1; R01CA225701-01A1; R01CA231471-01A1) and National Institutes of Nursing Research (R21NR016736-01), Helsinn Therapeutics and Insys Therapeutics during the conduct of the study.

  • Competing interests DH received grants from Helsinn outside the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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