Research Article

Relationships among clinicians are crucial to successful palliative care integration: a qualitative study in lung cancer

*Author for correspondence: Tel.: +1 503 220 8286;

Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University OHSU, Portland, OR 97239, USA

Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System (VAPORHCS), Portland, OR 97239, USA

Cancer Prevention & Control Program, Knight Cancer Institute, OHSU, Portland, OR 97239, USA

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Kelly C Vranas

Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University OHSU, Portland, OR 97239, USA

Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System (VAPORHCS), Portland, OR 97239, USA

Section of Pulmonary & Critical Care Medicine, VAPORHCS, Portand, OR 97239, USA

Department of Medicine, Palliative & Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA

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Molly Delorit

Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System (VAPORHCS), Portland, OR 97239, USA

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Sara E Golden

Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System (VAPORHCS), Portland, OR 97239, USA

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Christopher G Slatore

Division of Pulmonary & Critical Care Medicine, Oregon Health & Science University OHSU, Portland, OR 97239, USA

Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System (VAPORHCS), Portland, OR 97239, USA

Cancer Prevention & Control Program, Knight Cancer Institute, OHSU, Portland, OR 97239, USA

Section of Pulmonary & Critical Care Medicine, VAPORHCS, Portand, OR 97239, USA

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Linda Ganzini

Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System (VAPORHCS), Portland, OR 97239, USA

Department of Psychiatry, Division of Geriatric Psychiatry, OHSU, Portland, OR 97239, USA

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Lissi Hansen

Cancer Prevention & Control Program, Knight Cancer Institute, OHSU, Portland, OR 97239, USA

School of Nursing, OHSU, Portland, OR 97239, USA

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Published Online:28 Mar 2023https://doi.org/10.2217/fon-2022-0958

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Abstract

Aims: Palliative care integration improves quality of life among patients with lung cancer and their families. Despite these benefits, significant barriers persist and patients do not receive timely integration. This study sought to identify facilitators of and barriers to integration in lung cancer care. Materials & methods: Semistructured qualitative interviews were conducted with palliative care and lung cancer clinicians and analyzed using traditional content analysis. 23 clinicians were interviewed from geographically dispersed hospitals within a national healthcare system. Results: Palliative care integration improved over time, enhanced by several facilitators stratified at four levels (patient/clinician/hospital/organization). Most important among these was multidisciplinary care delivered in outpatient settings, fostering trust and relationships among clinicians which were pivotal to successful integration. Workforce shortages and limited use of primary palliative care among lung cancer clinicians need to be addressed for continued growth in the field. Conclusion: Relationships among clinicians are crucial to successful palliative care integration in lung cancer care.

Plain language summary

Palliative care is a form of supportive care for patients with a serious illness that improves quality of life among patients with lung cancer and their families. Unfortunately, many patients do not receive this care until they are near the end of life. This study sought to explore clinicians' perspectives regarding ways to enhance the use of palliative care among patients with lung cancer. Using interviews of clinicians from geographically dispersed hospitals within a national healthcare system, the authors explored reasons and potential solutions to improve palliative care delivery. One of the most important factors in enhancing palliative care use was fostering trust and relationships among palliative care and lung cancer clinicians. Workforce shortages also need to be addressed for continued growth in the field of palliative care. Relationships among clinicians are crucial to successful palliative care integration in lung cancer care.

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Papers of special note have been highlighted as: • of interest; •• of considerable interest

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Vol. 19, No. 3

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History

Received 27 September 2022

Accepted 19 January 2023

Published online 28 March 2023

Published in print January 2023

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Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.futuremedicine.com/doi/suppl/10.2217/fon-2022-0958

Author contributions

Conception or design of the work: DR Sullivan and CG Slatore; acquisition, analysis or interpretation of data for the work: all authors; drafting of the work or revising it critically for important intellectual content: all authors; final approval: all authors.

Acknowledgments

The authors wish to thank all the clinicians who generously volunteered to participate in the study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Department of Veterans Affairs did not have a role in the conduct of the study; in the collection, management, analysis or interpretation of the data; or in the preparation of the manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Financial & competing interests disclosure

This work was supported by the National Cancer Institute of the National Institutes of Health under award number K07CA190706 (DR Sullivan). DR Sullivan, KC Vranas, SE Golden and CG Slatore are supported by resources from the Center to Improve Veteran Involvement in Care (CIVIC) at the Veterans Affairs Portland Health Care System. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

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