title: Attitudes and Beliefs Toward Supportive and Palliative Care Referral Among Hematologic and Solid Tumor Oncology Specialists.
abstract: BACKGROUND
  Palliative care (PC) referrals are often delayed for patients with hematologic malignancies. We examined the differences in attitudes and beliefs toward PC referral between hematologic and solid tumor specialists and how their perception changed with use of the service name "supportive care" (SC).
  
  
  METHODS
  We randomly surveyed 120 hematologic and 120 solid tumor oncology specialists at our tertiary care cancer center to examine their attitudes and beliefs toward PC and SC referral.
  
  
  RESULTS
  Of the 240 specialists, 182 (76%) responded. Compared with solid tumor specialists, hematologic specialists were less likely to report that they would refer symptomatic patients with newly diagnosed cancer to PC (solid tumor, 43% vs. hematology, 21%; p = .002). A significantly greater proportion of specialists expressed that they would refer a patient with newly diagnosed cancer to SC than PC (solid tumor specialists: SC, 81% vs. PC, 43%; p < .001; hematology specialists: SC, 66% vs. PC, 21%; p < .001). The specialists perceived that PC was more likely than SC to be a barrier for referral (PC, 36% vs. SC, 3%; p < .001), to be synonymous with hospice (PC, 53% vs. SC, 6%; p < .001), to decrease hope (PC, 58% vs. SC, 8%; p < .001), and to be less appropriate for treatment of chemotherapy side effects (PC, 64% vs. SC, 19%; p < .001). On multivariate analysis, female clinicians (odds ratio [OR], 4.5; 95% confidence interval [CI], 1.3-15.2; p = .02) and the perception that PC is a barrier for referral (OR, 3.0; 95% CI, 1.2-7.6; p = .02) were associated with PC referral if the service name "SC" was used.
  
  
  CONCLUSIONS
  Hematologic specialists were less likely to refer patients early in the disease trajectory and were conducive to referral with the service name SC instead of PC.
  
  
  CONCLUSIONS
  The present survey of oncology specialists found that hematologic specialists were less likely than solid tumor specialists to report that they would refer symptomatic patients with newly diagnosed cancer to palliative care. However, both groups were significantly more willing to refer patients early in the disease trajectory if the service name "supportive care" were used instead of "palliative care." These findings suggest that rebranding might help to overcome the stigma associated with palliative care and improve patient access to palliative care services.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA dhui@mdanderson.org.
authors.forename: David
authors.initials: D
authors.lastname: Hui
authors.affiliation: Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Minjeong
authors.initials: M
authors.lastname: Park
authors.affiliation: Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Akhila
authors.initials: A
authors.lastname: Reddy
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Shalini
authors.initials: S
authors.lastname: Dalal
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D019337:Hematologic Neoplasms / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000941:ethics; D008875:Middle Aged; D010166:Palliative Care; D010820:Physicians; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013727:Terminal Care
keywords: Access; Hematology; Neoplasms; Palliative care; Referral; Supportive care