Supportive versus Palliative care: What's in a name?

Nada Fadul, Ahmed Elsayem, J. Lynn Palmer, Egidio Del Fabbro, Kay Swint, Zhijun Li, Valerie Poulter, Eduardo Bruera

Research output: Contribution to journalArticlepeer-review

230 Scopus citations

Abstract

Background: Palliative care has been progressively adopted by American cancer centers; however, referrals to palliative care continue to occur late in the trajectory of illness. It was hypothesized that the perceived association between the name palliative care and hospice was a barrier to early patients' referral. The objectives of this study were to determine the perception of the impact of the name palliative care compared with supportive care on patient referral and to determine whether there was an association between demographic factors and the perceptions of the 2 names by medical oncologists and their midlevel providers (advance practice nurses and physician assistants) at a comprehensive cancer center. METHODS: A survey was conducted among a random sample of 100 medical oncologists and 100 midlevel providers from The University of Texas M. D. Anderson Cancer Center. Information was collected on demographics, previous experience in palliative care, and attitudes and beliefs toward the impact of the name palliative care compared with supportive care on patient referral. RESULTS: A total of 140 of 200 (70%) participants responded (74 midlevel providers and 66 medical oncologists). Median age was 43 years (range. 34.5-50 years), and there were 83 (60%) women. Midlevel providers and medical oncologists generally agreed in their responses to most of the items. More participants preferred the name supportive care (80, 57%) compared with palliative care (27, 19% P <.0001). Medical oncologists and midlevel providers stated increased likelihood to refer patients on active primary (79 vs 45%, P <.0001) and advanced cancer (89 vs 69%, P <.0001) treatments to a service named supportive care. The name palliative care compared with supportive care was perceived more frequently by medical oncologists and midlevel providers as a barrier to referral (23 vs 6% P <..0001), decreasing hope (44 vs 11% P <..0001), and causing distress (33 vs 3% P <.0001) in patients and families. There were no significant associations among the perception of the 2 names and age (P =.82), sex (P =.35), or prior training in palliative care (P >.99). CONCLUSIONS: The name palliative care was perceived by medical oncologists and midlevel providers as more distressing and reducing hope to patients and families. Medical oncologists and midlevel providers significantly prefer the name supportive care and stated more likelihood to refer patients on active primary and advanced cancer treatments to a service named supportive care.

Original languageEnglish (US)
Pages (from-to)2013-2021
Number of pages9
JournalCancer
Volume115
Issue number9
DOIs
StatePublished - May 1 2009
Externally publishedYes

Keywords

  • Advanced cancer
  • Palliative care
  • Patient referral
  • Supportive care

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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