title: Acceptability of early integration of palliative care in patients with incurable lung cancer.
abstract: BACKGROUND
  Lung cancer remains the leading cause of cancer death, and it is known many affected will have significant palliative care needs. Evidence suggests that early involvement of palliative care can translate into improvements in quality of care, quality of life, and survival. However, routine early integration is yet to be embraced as standard of care for the majority of patients, and it is unclear what lung cancer clinicians continue to perceive as the barriers to this model of care.
  
  
  METHODS
  We performed a qualitative exploration of lung cancer clinicians' perceptions, focusing on current experiences of engaging with palliative care, perceptions of palliative care for patients with lung cancer, and views of barriers and benefits of referring to palliative care.
  
  
  RESULTS
  Focus group and targeted interviews were conducted with 28 clinicians, with four key emergent themes: 1) Competence/skill--with referrers needing to be confident in the quality and capability of palliative care provision; 2) Care Coordination--the need to ensure integrated care, with defined lines of responsibility and clear team communication; 3) Ease of referral--the need for ready access to a palliative care provider in the lung cancer clinic; and 4) Perceptions--concerns about loss of hope and fears of negative patient reaction.
  
  
  CONCLUSIONS
  Early and routine involvement of palliative care in patients with incurable lung cancer is acceptable to the majority of treating clinicians. To facilitate early integration of palliative care, palliative care providers need to become front-line team members who provide a high-quality service. Lung cancer clinicians need further education as to the role and benefits of early palliative care, and how best to introduce this.
authors.affiliation: 1 Department of Palliative Care, The Royal Melbourne Hospital , Parkville, Victoria, Australia .
authors.forename: Brian H C
authors.initials: BH
authors.lastname: Le
authors.forename: Linda
authors.initials: L
authors.lastname: Mileshkin
authors.forename: Katie
authors.initials: K
authors.lastname: Doan
authors.forename: Di
authors.initials: D
authors.lastname: Saward
authors.forename: Odette
authors.initials: O
authors.lastname: Spruyt
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Yoong
authors.forename: Dishan
authors.initials: D
authors.lastname: Gunawardana
authors.forename: Matthew
authors.initials: M
authors.lastname: Conron
authors.forename: Jennifer
authors.initials: J
authors.lastname: Philip
mesh_terms: D001291:Attitude of Health Personnel; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration / Q000592:standards; D005260:Female; D017144:Focus Groups; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D008175:Lung Neoplasms; D008297:Male; D010166:Palliative Care / Q000523:psychology / Q000592:standards*; D010348:Patient Care Team / Q000458:organization & administration; D036301:Qualitative Research; D011788:Quality of Life; D012017:Referral and Consultation / Q000592:standards; D019452:Terminally Ill / Q000523:psychology*; D013997:Time Factors; D014739:Victoria