Office of Research & Development

print icon sign up for VA Research updates
VA RESEARCH QUARTERLY UPDATE
This Issue: The Aging Veteran | Table of Contents: Summer 2017 | Download this issue

Noteworthy Publications

Provider challenges in delivering end-of-life cancer care


Doctors and other cancer-care team members often wish they could spend more time educating patients and care givers, says research. <em>(Photo for illustrative purposes only, ©iStock/bowdenimages)</em>
Doctors and other cancer-care team members often wish they could spend more time educating patients and care givers, says research. (Photo for illustrative purposes only, ©iStock/bowdenimages)

Doctors and other cancer-care team members often wish they could spend more time educating patients and care givers, says research. (Photo for illustrative purposes only, ©iStock/bowdenimages)

To learn about provider perspectives on end-of-life cancer care, researchers at the VA Palo Alto Health Care System, Stanford University, and Washington University interviewed 75 oncology providers (physicians, nurses, social workers, and patient advocates) to solicit their views on EOL cancer care and ask for suggestions to improve practice design.

Studies show that both providers and cancer patients are interested in improving the effectiveness of EOL cancer care. However, little work has been done to measure provider support for care delivery improvements.

The study results were published online July 10, 2017, in the American Journal of Hospice and Palliative Medicine.

The researchers conducted semi-structured interviews that were transcribed, coded, and analyzed using a "constant comparative" method—based on thematic analysis—to identify recurring themes.

The provider interviews revealed six common themes that fell into two categories: roadblocks to providing the best patient care, and ways to improve practice design.

Providers said they experienced these challenges in delivering quality cancer care to their patients:

1. Lack of time for educating patients and caregivers.

2. Ambiguity in determining prognosis/timing of palliative care.

3. Lack of systems to support non-face-to-face patient communication.

Providers said they felt these clinical practice improvements would help them manage their time better:

1. Use of a lay health worker to assist in care planning.

2. Use of non-face-to-face patient communication to address symptom management.

3. Use of in-home/community cancer care services.

Concerning in-home care, one nurse said: "We give chemotherapy to kids all the time at home. There are a lot of things we could do in the home for adult patients as well, but we don't because the payment system is set up to reward doing this in the infusion center. Many of our chemotherapies can be safely given to patients at home …"

Most of the suggested solutions were not unique and had been proposed in previous studies. The researchers concluded that physicians and other cancer care providers should have more input on barriers to EOL cancer care and should be asked for their suggestions on practice improvements.

Cancer care in the United States is complex and costly. It requires a multidisciplinary patient care team composed of physicians, nurses, technicians, social workers, and patient advocates. Care providers are often pressured to see large volumes of patients, and in the midst of administrative and financial pressures, end-of-life care can inadvertently be given short shrift.


Questions about the R&D website? Email the Web Team.

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.