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Oncology Clinicians’ Challenges to Providing Palliative Cancer Care—A Theoretical Domains Framework, Pan-Cancer System Survey

Despite the known benefits, healthcare systems struggle to provide early, integrated palliative care (PC) for advanced cancer patients. Understanding the barriers to providing PC from the perspective of oncology clinicians is an important first step in improving care. A 33-item online survey was ema...

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Autores principales: Dunn, Sharlette, Earp, Madelene A., Biondo, Patricia, Cheung, Winson Y., Kerba, Marc, Tang, Patricia A., Sinnarajah, Aynharan, Watanabe, Sharon M., Simon, Jessica E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167753/
https://www.ncbi.nlm.nih.gov/pubmed/33918837
http://dx.doi.org/10.3390/curroncol28020140
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author Dunn, Sharlette
Earp, Madelene A.
Biondo, Patricia
Cheung, Winson Y.
Kerba, Marc
Tang, Patricia A.
Sinnarajah, Aynharan
Watanabe, Sharon M.
Simon, Jessica E.
author_facet Dunn, Sharlette
Earp, Madelene A.
Biondo, Patricia
Cheung, Winson Y.
Kerba, Marc
Tang, Patricia A.
Sinnarajah, Aynharan
Watanabe, Sharon M.
Simon, Jessica E.
author_sort Dunn, Sharlette
collection PubMed
description Despite the known benefits, healthcare systems struggle to provide early, integrated palliative care (PC) for advanced cancer patients. Understanding the barriers to providing PC from the perspective of oncology clinicians is an important first step in improving care. A 33-item online survey was emailed to all oncology clinicians working with all cancer types in Alberta, Canada, from November 2017 to January 2018. Questions were informed by Michie’s Theoretical Domains Framework and Behaviour Change Wheel (BCW) and queried (a) PC provision in oncology clinics, (b) specialist PC consultation referrals, and (c) working with PC consultants and home care. Respondents (n = 263) were nurses (41%), physicians (25%), and allied healthcare professionals (18%). Barriers most frequently identified were “clinicians’ limited time/competing priorities” (64%), “patients’ negative perceptions of PC” (63%), and clinicians’ capability to manage patients’ social issues (63%). These factors mapped to all three BCW domains: motivation, opportunity, and capability. In contrast, the least frequently identified barriers were clinician motivation and perceived PC benefits. Oncology clinicians’ perceptions of barriers to early PC were comparable across tumour types and specialties but varied by professional role. The main challenges to early integrated PC include all three BCW domains. Notably, motivation is not a barrier for oncology clinicians; however, opportunity and capability barriers were identified. Multifaceted interventions using these findings have been developed, such as tip sheets to enhance capability, reframing PC with patients, and earlier specialist PC nursing access, to enhance clinicians’ use of and patients’ benefits from an early PC approach.
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spelling pubmed-81677532021-06-02 Oncology Clinicians’ Challenges to Providing Palliative Cancer Care—A Theoretical Domains Framework, Pan-Cancer System Survey Dunn, Sharlette Earp, Madelene A. Biondo, Patricia Cheung, Winson Y. Kerba, Marc Tang, Patricia A. Sinnarajah, Aynharan Watanabe, Sharon M. Simon, Jessica E. Curr Oncol Article Despite the known benefits, healthcare systems struggle to provide early, integrated palliative care (PC) for advanced cancer patients. Understanding the barriers to providing PC from the perspective of oncology clinicians is an important first step in improving care. A 33-item online survey was emailed to all oncology clinicians working with all cancer types in Alberta, Canada, from November 2017 to January 2018. Questions were informed by Michie’s Theoretical Domains Framework and Behaviour Change Wheel (BCW) and queried (a) PC provision in oncology clinics, (b) specialist PC consultation referrals, and (c) working with PC consultants and home care. Respondents (n = 263) were nurses (41%), physicians (25%), and allied healthcare professionals (18%). Barriers most frequently identified were “clinicians’ limited time/competing priorities” (64%), “patients’ negative perceptions of PC” (63%), and clinicians’ capability to manage patients’ social issues (63%). These factors mapped to all three BCW domains: motivation, opportunity, and capability. In contrast, the least frequently identified barriers were clinician motivation and perceived PC benefits. Oncology clinicians’ perceptions of barriers to early PC were comparable across tumour types and specialties but varied by professional role. The main challenges to early integrated PC include all three BCW domains. Notably, motivation is not a barrier for oncology clinicians; however, opportunity and capability barriers were identified. Multifaceted interventions using these findings have been developed, such as tip sheets to enhance capability, reframing PC with patients, and earlier specialist PC nursing access, to enhance clinicians’ use of and patients’ benefits from an early PC approach. MDPI 2021-04-09 /pmc/articles/PMC8167753/ /pubmed/33918837 http://dx.doi.org/10.3390/curroncol28020140 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Dunn, Sharlette
Earp, Madelene A.
Biondo, Patricia
Cheung, Winson Y.
Kerba, Marc
Tang, Patricia A.
Sinnarajah, Aynharan
Watanabe, Sharon M.
Simon, Jessica E.
Oncology Clinicians’ Challenges to Providing Palliative Cancer Care—A Theoretical Domains Framework, Pan-Cancer System Survey
title Oncology Clinicians’ Challenges to Providing Palliative Cancer Care—A Theoretical Domains Framework, Pan-Cancer System Survey
title_full Oncology Clinicians’ Challenges to Providing Palliative Cancer Care—A Theoretical Domains Framework, Pan-Cancer System Survey
title_fullStr Oncology Clinicians’ Challenges to Providing Palliative Cancer Care—A Theoretical Domains Framework, Pan-Cancer System Survey
title_full_unstemmed Oncology Clinicians’ Challenges to Providing Palliative Cancer Care—A Theoretical Domains Framework, Pan-Cancer System Survey
title_short Oncology Clinicians’ Challenges to Providing Palliative Cancer Care—A Theoretical Domains Framework, Pan-Cancer System Survey
title_sort oncology clinicians’ challenges to providing palliative cancer care—a theoretical domains framework, pan-cancer system survey
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167753/
https://www.ncbi.nlm.nih.gov/pubmed/33918837
http://dx.doi.org/10.3390/curroncol28020140
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