title: Perceptions of palliative care among hematologic malignancy specialists: a mixed-methods study.
abstract: OBJECTIVE
  Patients with hematologic malignancies are less likely to receive specialist palliative care services than patients with solid tumors. Reasons for this difference are poorly understood.
  
  
  METHODS
  This was a multisite, mixed-methods study to understand and contrast perceptions of palliative care among hematologic and solid tumor oncologists using surveys assessing referral practices and in-depth semistructured interviews exploring views of palliative care. We compared referral patterns using standard statistical methods. We analyzed qualitative interview data using constant comparative methods to explore reasons for observed differences.
  
  
  RESULTS
  Among 66 interviewees, 23 oncologists cared exclusively for patients with hematologic malignancies; 43 treated only patients with solid tumors. Seven (30%) of 23 hematologic oncologists reported never referring to palliative care; all solid tumor oncologists had previously referred. In qualitative analyses, most hematologic oncologists viewed palliative care as end-of-life care, whereas most solid tumor oncologists viewed palliative care as a subspecialty that could assist with complex patient cases. Solid tumor oncologists emphasized practical barriers to palliative care referral, such as appointment availability and reimbursement issues. Hematologic oncologists emphasized philosophic concerns about palliative care referrals, including different treatment goals, responsiveness to chemotherapy, and preference for controlling even palliative aspects of patient care.
  
  
  CONCLUSIONS
  Most hematologic oncologists view palliative care as end-of-life care, whereas solid tumor oncologists more often view palliative care as a subspecialty for comanaging patients with complex cases. Efforts to integrate palliative care into hematologic malignancy practices will require solutions that address unique barriers to palliative care referral experienced by hematologic malignancy specialists.
authors.affiliation: Duke University School of Medicine; Duke Clinical Research Institute, Durham, NC; Northwestern University Feinberg School of Medicine, Chicago, IL; University of California San Francisco, San Francisco, CA; Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pittsburgh, Pittsburgh, PA thomas.leblanc@duke.edu.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: LeBlanc
authors.affiliation: Duke University School of Medicine; Duke Clinical Research Institute, Durham, NC; Northwestern University Feinberg School of Medicine, Chicago, IL; University of California San Francisco, San Francisco, CA; Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pittsburgh, Pittsburgh, PA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: O'Donnell
authors.affiliation: Duke University School of Medicine; Duke Clinical Research Institute, Durham, NC; Northwestern University Feinberg School of Medicine, Chicago, IL; University of California San Francisco, San Francisco, CA; Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pittsburgh, Pittsburgh, PA.
authors.forename: Megan
authors.initials: M
authors.lastname: Crowley-Matoka
authors.affiliation: Duke University School of Medicine; Duke Clinical Research Institute, Durham, NC; Northwestern University Feinberg School of Medicine, Chicago, IL; University of California San Francisco, San Francisco, CA; Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pittsburgh, Pittsburgh, PA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Rabow
authors.affiliation: Duke University School of Medicine; Duke Clinical Research Institute, Durham, NC; Northwestern University Feinberg School of Medicine, Chicago, IL; University of California San Francisco, San Francisco, CA; Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pittsburgh, Pittsburgh, PA.
authors.forename: Cardinale B
authors.initials: CB
authors.lastname: Smith
authors.affiliation: Duke University School of Medicine; Duke Clinical Research Institute, Durham, NC; Northwestern University Feinberg School of Medicine, Chicago, IL; University of California San Francisco, San Francisco, CA; Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pittsburgh, Pittsburgh, PA.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: White
authors.affiliation: Duke University School of Medicine; Duke Clinical Research Institute, Durham, NC; Northwestern University Feinberg School of Medicine, Chicago, IL; University of California San Francisco, San Francisco, CA; Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pittsburgh, Pittsburgh, PA.
authors.forename: Greer A
authors.initials: GA
authors.lastname: Tiver
authors.affiliation: Duke University School of Medicine; Duke Clinical Research Institute, Durham, NC; Northwestern University Feinberg School of Medicine, Chicago, IL; University of California San Francisco, San Francisco, CA; Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pittsburgh, Pittsburgh, PA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
authors.affiliation: Duke University School of Medicine; Duke Clinical Research Institute, Durham, NC; Northwestern University Feinberg School of Medicine, Chicago, IL; University of California San Francisco, San Francisco, CA; Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pittsburgh, Pittsburgh, PA.
authors.forename: Yael
authors.initials: Y
authors.lastname: Schenker
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D019337:Hematologic Neoplasms; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D010166:Palliative Care; D010465:Perception; D010818:Practice Patterns, Physicians'; D013038:Specialization; D011795:Surveys and Questionnaires