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Palliative care from the perspective of cancer physicians: a qualitative semistructured interviews study
  1. Guillaume Economos1,
  2. Alice Bonneville-Levard2,
  3. Ines Djebari3,
  4. Kevin Van Thuynes3,
  5. Colombe Tricou4,
  6. Élise Perceau-Chambard4 and
  7. Marilene Filbet4
  1. 1EA 37.38 - Centre d’Innovation en Cancérologie de Lyon (CICLy), Universite Claude Bernard Lyon 1 Faculte de medecine Lyon-Sud, Oullins, France
  2. 2Departement of Medical oncology, Centre Léon Bérard, Lyon, Rhône-Alpes, France
  3. 3Institut de psychologie, Université Lumière Lyon 2, Lyon, Auvergne-Rhône-Alpes, France
  4. 4Palliative Care, Hospices Civils de Lyon, Lyon, France
  1. Correspondence to Dr Guillaume Economos, EA 37.38 - Centre d’Innovation en Cancérologie de Lyon (CICLy), Universite Claude Bernard Lyon 1 Faculte de medecine Lyon-Sud, Oullins 69437, France; economos.guillaume{at}gmail.com

Abstract

Objective Integrated palliative care for populations with cancer is now highly recommended. However, numerous physicians working in cancer care are still reluctant to refer patients to specialist palliative care teams. This study explores their perceptions of palliative care and factors influencing reasons to refer to specialist palliative care.

Methods We used a qualitative methodology based on semistructured interviews with physicians working in cancer care, in two tertiary hospitals and one comprehensive cancer centre with access to a specialist palliative care team. Forty-six physicians were invited and 18 interviews were performed until data saturation. Participants were mainly men, licensed in cancer care, 37.9 years old on average and had 13 years of professional experience. The length of interviews was on average 34 min (SD=3). Analysis was performed accordingly with the thematic analysis.

Results The data analysis found four themes: symptom management as a trigger, psychosocial support, mediation provided by interventions, and the association with terminal care or death. Palliative care integrated interventions were mainly perceived as holistic approaches that offered symptom management expertise and time. They were valued for helping in consolidating decision-making from a different or external perspective, or an ‘outside look’. Several barriers were identified, often due to the confusion between terminal care and palliative care. This was further highlighted by the avoidance of the words ‘palliative care’, which were associated with death.

Conclusions National policies for promoting palliative care seemed to have failed in switching oncologists' perception of palliative care, which they still consider as terminal care.

  • cancer
  • symptoms and symptom management
  • clinical decisions

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Footnotes

  • Contributors GE undertook legal requirements, supervised the analysis and drafted the main manuscript. ABL had the original idea, designed the study, analysed the interviews and revised and approved the main manuscript. ID and KVT undertook the interviews. CT and EPC supervised data collection and were involved in data analyses as external reviewers of the themes, reviewed and approved the manuscript. MF codesigned the methodology, supervised the project, reviewed and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request.

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