title: Impact of provider level, training and gender on the utilization of palliative care and hospice in neuro-oncology: a North-American survey.
abstract: Specialized palliative care (PC) services have emerged to address symptoms and provide end-of-life management for patients with brain tumors. The utilization patterns of PC in neuro-oncology are unknown. A 22-question survey was distributed to participants of the society for neuro-oncology annual meeting 2012 (n = 4487). Nonparametric methods including Wilcoxon two-sample and Kruskal-Wallis tests were used to assess differences in responses. 239 (5.3 %) evaluable responses were received; 79 % of respondents were physicians, and 17 % were nurses or midlevel providers. Forty-seven percent were medical or neuro-oncologists, 31 % neurosurgeons and 11 % radiation oncologists. Forty percent had no formal training in PC, 57 % had some formal training and 3 % completed a PC fellowship. Seventy-nine percent practiced in an academic setting. Of the respondents, 57 % referred patients to PC when symptoms required treatment and 18 % at end of life. Only 51 % of all providers felt comfortable dealing with end-of-life issues and symptoms, while 33 % did not. Fifty-one percent preferred a service named "Supportive Care" rather than "Palliative Care" (MDs > midlevel providers, p < 0.001), and 32 % felt that patient expectations for ongoing therapy hindered their ability to make PC referrals. Female gender, formal training in neuro-oncology and PC, and medical versus surgical neuro-oncology training were significantly associated with hospice referral, comfort in dealing with end-of-life issues, and ease of access to PC services. Provider level, specialty, gender, training in PC and neuro-oncology have significant impact on the utilization of PC and hospice in neuro-oncology.
authors.affiliation: Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA. twalber1@hfhs.org.|Department of Neurology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA. twalber1@hfhs.org.
authors.forename: Tobias
authors.initials: T
authors.lastname: Walbert
authors.affiliation: Department of Neurosurgery, Penn State Hershey, Hershey, PA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Glantz
authors.affiliation: Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
authors.forename: Lonni
authors.initials: L
authors.lastname: Schultz
authors.affiliation: The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Puduvalli
mesh_terms: D001932:Brain Neoplasms / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D006738:Hospices; D006801:Humans; D008297:Male; D008495:Medical Oncology; D009656:North America; D010166:Palliative Care; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D012737:Sex Factors
keywords: End-of-life; Glioblastoma; Glioma; Palliative care; Supportive care