title: Early Palliative Care and Its Role in Oncology: A Qualitative Study.
abstract: BACKGROUND
  Early integration of palliative care alongside oncology is being increasingly recommended, although the strategies and models for integration remain poorly defined. We solicited the opinions of patients and caregivers who participated in a randomized trial of early palliative care versus standard oncology care, regarding the respective roles of their oncologist (both groups) and palliative care physician (early palliative care group).
  
  
  METHODS
  The study was performed at a comprehensive cancer center. Forty-eight patients (26 intervention, 22 control) and 23 caregivers (14 intervention, 9 control) were recruited purposefully at trial end. One-on-one, semistructured qualitative interviews were conducted and analyzed using grounded theory.
  
  
  RESULTS
  The themes resulting from the analysis fell into three categories: the focus of care, the model of care delivery, and the complementarity between teams. The focus of care in oncology was perceived to be disease-centered, with emphasis on controlling disease, directing cancer treatment, and increasing survival; palliative care was perceived to be more holistic and person-focused, with an emphasis on symptom management. Oncology visits were seen as following a structured, physician-led, time-constrained model in contrast to the more fluid, patient-led, flexible model experienced in the palliative care clinic. No differences were found in the descriptions of oncology between participants in the intervention and control groups. Participants in the intervention group explicitly described the roles of their oncologist and their palliative care physician as distinct and complementary.
  
  
  CONCLUSIONS
  Participants perceived the respective roles of their oncologist and palliative care physician as discrete, important, and complementary for the provision of excellent cancer care.
  
  
  CONCLUSIONS
  Patients and their caregivers who experienced early palliative care described the roles of their oncologists and palliative care physicians as being discrete and complementary, with both specialties contributing to excellent patient care. The findings of the present research support an integrated approach to care for patients with advanced cancer, which involves early collaborative care in the ambulatory setting by experts in both oncology and palliative medicine. This can be achieved by more widespread establishment of ambulatory palliative care clinics, encouragement of timely outpatient referral to palliative care, and education of oncologists in palliative care.
authors.affiliation: Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Breffni
authors.initials: B
authors.lastname: Hannon
authors.affiliation: Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Nadia
authors.initials: N
authors.lastname: Swami
authors.affiliation: Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Ashley
authors.initials: A
authors.lastname: Pope
authors.affiliation: Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Natasha
authors.initials: N
authors.lastname: Leighl
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.|Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.|Campbell Family Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Rodin
authors.affiliation: Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Monika
authors.initials: M
authors.lastname: Krzyzanowska
authors.affiliation: Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada camilla.zimmermann@uhn.ca.|Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.|Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.|Campbell Family Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
keywords: Ambulatory care; Medical oncology; Palliative care; Professional role; Qualitative research