title: Oncologist factors that influence referrals to subspecialty palliative care clinics.
abstract: OBJECTIVE
  Recent research and professional guidelines support expanded use of outpatient subspecialty palliative care in oncology, but provider referral practices vary widely. We sought to explore oncologist factors that influence referrals to outpatient palliative care.
  
  
  METHODS
  Multisite, qualitative interview study at three academic cancer centers in the United States with well-established palliative care clinics. Seventy-four medical oncologists participated in semistructured interviews between February and October 2012. The interview guide asked about experiences and decision making regarding outpatient palliative care use. A multidisciplinary team analyzed interview transcripts using constant comparative methods to inductively develop and refine themes related to palliative care referral decisions.
  
  
  RESULTS
  We identified three main oncologist barriers to subspecialty palliative care referrals at sites with comprehensive palliative care clinics: persistent conceptions of palliative care as an alternative philosophy of care incompatible with cancer therapy, a predominant belief that providing palliative care is an integral part of the oncologist's role, and a lack of knowledge about locally available services. Participants described their views of subspecialty palliative care as evolving in response to increasing availability of services and positive referral experiences, but emphasized that views of palliative care as valuable in addition to standard oncology care were not universally shared by oncologists.
  
  
  CONCLUSIONS
  Improving provision of palliative care in oncology will likely require efforts beyond increasing service availability. Raising awareness of ways in which subspecialty palliative care complements standard oncology care and developing ways for oncologists and palliative care physicians to collaborate and integrate their respective skills may help.
authors.affiliation: University of Pittsburgh Cancer Institute; University of Pittsburgh, Pittsburgh, PA; Feinberg School of Medicine, Northwestern University, Chicago, IL; Institute for Health Policy Studies; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA; and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Yael
authors.initials: Y
authors.lastname: Schenker
authors.forename: Megan
authors.initials: M
authors.lastname: Crowley-Matoka
authors.forename: Daniel
authors.initials: D
authors.lastname: Dohan
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rabow
authors.forename: Cardinale B
authors.initials: CB
authors.lastname: Smith
authors.forename: Douglas B
authors.initials: DB
authors.lastname: White
authors.forename: Edward
authors.initials: E
authors.lastname: Chu
authors.forename: Greer A
authors.initials: GA
authors.lastname: Tiver
authors.forename: Sara
authors.initials: S
authors.lastname: Einhorn
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000553:Ambulatory Care; D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D010166:Palliative Care; D010819:Physician's Role; D010820:Physicians; D036301:Qualitative Research; D012017:Referral and Consultation; D014481:United States