title: Oncologist Experience Implementing Goals of Care Discussions in Everyday Ambulatory Oncology Practice: Implications for Education.
abstract: Despite evidence that Goals of Care (GOC) discussions should occur early in the disease trajectory, the majority occur close to end of life. In a pilot, oncologists routinely initiated GOC discussions with all patients in their everyday ambulatory practice. Following the pilot, 9 of 12 eligible oncologists participated in semi-structured interviews about their experiences. Analysis resulted in the identification of seven principles of good GOC discussions embedded in the oncologists' interviews, four barriers to engaging in GOC discussions and foundational education needs. Participants believed that the appropriate trigger for a GOC discussion is a diagnosis of advanced cancer, not simply a diagnosis of cancer, and supported the importance of selective and strategic targeting of GOC discussions. The findings have informed the development of an education-based model for culture change within a province-wide cancer care system.
authors.affiliation: School of Nursing, University of British Columbia, ART 132, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada. carole.robinson@ubc.ca.
authors.forename: Carole A
authors.initials: CA
authors.lastname: Robinson
authors.affiliation: Medical Lead, Pain and Symptom Management Palliative Care Program, BC Cancer Agency Sindi Ahluwalia Hawkins Centre for the Southern Interior, 399 Royal Avenue, Kelowna, BC, V1Y 5L3, Canada.
authors.forename: Gillian
authors.initials: G
authors.lastname: Fyles
authors.affiliation: Radiation Therapy Program, BC Cancer Agency Vancouver Cancer Centre, 600 West 10th Avenue, Vancouver, BC, V6S 1R6, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: McKenzie
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D018450:Disease Progression; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008495:Medical Oncology; D000072103:Oncologists / Q000523:psychology*; D010166:Palliative Care; D010347:Patient Care Planning
keywords: Advance care planning; Ambulatory oncology; Goals of care; Oncology; Palliative care