title: Pediatric oncology providers' perceptions of barriers and facilitators to early integration of pediatric palliative care.
abstract: BACKGROUND
  Pediatric patients experience significant symptoms during cancer treatment. Symptom management is frequently inadequate. We studied perceptions of pediatric oncology care providers regarding early integration of palliative care (PC) for pediatric patients to identify barriers and facilitators that might assist in understanding how care could be improved.
  
  
  METHODS
  Pediatric oncology providers were recruited to participate in four focus groups. A proposal for early integration of a pediatric palliative care team (PPCT) was presented and followed by a facilitated discussion. Data were analytically categorized into themes by three independent coders using constant comparative analysis and crystallization techniques. A consensus approach was used to identify final themes.
  
  
  RESULTS
  Barriers to the proposed care model of early integration of a PPCT included provider role, conflicting philosophy, patient readiness, and emotional influence and were more prevalent in the physician participants compared to nurse practitioner, nursing, and social work participants. Facilitators included patient eligibility, improved patient care, education, and evidence-based medicine. Though all participants were invested in providing optimal patient care, physician participants believed the current standard of care model is meeting the needs of patients and family, while the nurse practitioner, nursing, and social work participants working on the same healthcare team believed the proposed care model would improve the overall care of children diagnosed with cancer.
  
  
  CONCLUSIONS
  Differing perceptions among healthcare providers regarding the care of children with cancer suggest that team functioning could be improved. Avenues for pilot testing early integration of PC could provide useful information for a next study.
authors.affiliation: Division of Pediatric Hematology-Oncology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon.
authors.forename: Todd
authors.initials: T
authors.lastname: Dalberg
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jacob-Files
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Carney
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Meyrowitz
authors.forename: Erik K
authors.initials: EK
authors.lastname: Fromme
authors.forename: Gregory
authors.initials: G
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000523:psychology*; D010372:Pediatrics
keywords: barriers; oncology; palliative care; pediatric; perceptions