title: Gynecologic Oncologist Views Influencing Referral to Outpatient Specialty Palliative Care.
abstract: Early specialty palliative care is underused for patients with advanced gynecologic malignancies. We sought to understand how gynecologic oncologists' views influence outpatient specialty palliative care referral to help inform strategies for improvement.
  
  
  
  We conducted a qualitative interview study at 6 National Cancer Institute-designated cancer centers with well-established outpatient palliative care services. Between September 2015 and March 2016, 34 gynecologic oncologists participated in semistructured telephone interviews focused on attitudes, experiences, and preferences related to outpatient specialty palliative care. A multidisciplinary team analyzed transcripts using constant comparative methods to inductively develop a coding framework. Through an iterative, analytic process, codes were classified, grouped, and refined into themes.
  
  
  
  Mean (SD) participant age was 47 (10) years. Mean (SD) interview length was 25 (7) minutes. Three main themes emerged regarding how gynecologic oncologists view outpatient specialty palliative care: (1) long-term relationships with patients is a unique and defining aspect of gynecologic oncology that influences referral, (2) gynecologic oncologists value palliative care clinicians' communication skills and third-party perspective to increase prognostic awareness and help negotiate differences between patient preferences and physician recommendation, and (3) gynecologic oncologists prefer specialty palliative care services embedded within gynecologic oncology clinics.
  
  
  
  Gynecologic oncologists value longitudinal relationships with patients and use specialty palliative care to negotiate conflict surrounding prognostic awareness or the treatment plan. Embedding specialty palliative care within gynecologic oncology clinics may promote communication between clinicians and facilitate gynecologic oncologist involvement throughout the illness course.
authors.affiliation: *Division of Gynecologic Oncology, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA; †Division of Gynecologic Oncology and ‡Palliative Care, Department of Medicine, University of Colorado Denver, Denver, CO; §Medical Education/Medical Humanities and Bioethics/Anthropology, Northwestern University, Chicago, IL; ∥Department of Medicine, School of Nursing, University of Alabama at Birmingham, Birmingham, AL; ¶Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC; #Division of Gynecologic Oncology, University of Virginia School of Medicine, Charlottesville, VA; **Division of Gynecologic Oncology, University of Washington, Seattle, WA; ††University of California Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; and ‡‡Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health; and §§Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Casey M
authors.initials: CM
authors.lastname: Hay
authors.forename: Carolyn
authors.initials: C
authors.lastname: Lefkowits
authors.forename: Megan
authors.initials: M
authors.lastname: Crowley-Matoka
authors.forename: Marie A
authors.initials: MA
authors.lastname: Bakitas
authors.forename: Leslie H
authors.initials: LH
authors.lastname: Clark
authors.forename: Linda R
authors.initials: LR
authors.lastname: Duska
authors.forename: Renata R
authors.initials: RR
authors.lastname: Urban
authors.forename: Lee-May
authors.initials: LM
authors.lastname: Chen
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Creasy
authors.forename: Yael
authors.initials: Y
authors.lastname: Schenker
mesh_terms: D000553:Ambulatory Care / Q000379:methods / Q000592:standards*; D001291:Attitude of Health Personnel; D002173:Cancer Care Facilities / Q000592:standards*; D005260:Female; D005833:Genital Neoplasms, Female / Q000628:therapy*; D006176:Gynecology / Q000592:standards; D006801:Humans; D008875:Middle Aged; D000072103:Oncologists; D010166:Palliative Care / Q000379:methods / Q000592:standards*; D012017:Referral and Consultation