Dissertations & Theses (Open Access)

Date of Award

Fall 8-2020

Degree Name

Doctor of Philosophy (PhD)

Advisor(s)

Paige Wermuth

Second Advisor

David Hui

Third Advisor

Dejian Lai

Abstract

Background: Interdisciplinary palliative care (PC) teams (IDTs) are essential to improving patient outcomes while cancer center executives have a key role in defining the future of PC. Objectives: To compare PC team compositions and executives’ attitudes towards PC between NCI (National Cancer Institute)-designated cancer centers (NCI-CCs) and non-NCI-designated cancer centers (non-NCI-CCs) in 2018 and to compare changes in team composition and executives’ attitudes and beliefs between 2009-2018. Methods: PC program leaders (PL) and cancer center executives at all 62 NCI-CCs and a random sample of 60 of 1252 non-NCI-CCs were surveyed from April-August 2018. The PL survey examined team composition and certification requirements. The primary outcome was the presence of an IDT defined as a PC physician, nurse, and psychosocial member. Secondary outcomes were the size and number of individual disciplines. The executives’ survey contained 12 questions examining attitudes towards PC integration, perceived barriers, and selfassessments. The primary outcome was agreement on the statement “a stronger integration of PC services into oncology practice will benefit patients at my institution.” Results: In 2018, 52/61 (85%) NCI-CCs and 27/38 (71%) non-NCI-CCs responded to the PL survey. NCI-CCs were more likely to have IDTs than non-NCI-CCs (92% vs. 67%; P=0.009). In contrast, non-NCI-CCs were more likely to have nurse-led teams (14.8% vs. 0.0%; P=0.01). The median number of disciplines did not differ between groups (NCI, 6.0; non-NCI, 5.0; P=0.08). Between 2009 and 2018, NCI-CCs and non-NCI-CCs saw increased proportions of centers with IDTs (NCI, 64.9% vs 92.0%, P<0.001; non-NCI, 40.0% vs. 66.7%; P=0.047). In 2018, 52/77 (68%) NCI-CCs and 88/126 (70%) non-NCI-CCs responded to the executives’ survey. A vast majority of executives at NCI-CCs and non-NCI-CCs endorsed PC integration (89.7% vs 90.0%; P>0.999). NCI-CCs were more likely to endorse increasing funding for PC (52.5% vs 23.1%; P=0.01) and hiring physician specialists (70.0% vs 37.5%; P=0.004) than non-NCI-CCs. The top 3 perceived barriers among NCI-CCs and non-NCI-CCs were limited institutional budgets (57.9% vs 59.0%; P=0.92), poor reimbursements (55.3% vs 43.6%; P=0.31), and lack of adequately trained palliative care physicians and nurses (52.6% vs 43.6%; P=0.43). Both NCICCs and non-NCI-CCs favorably rated their PC services (89.7% vs 71.8%; P=0.04) with no major changes since 2009. Conclusion: NCI-CCs were more likely to report having an IDT than non-NCI-CCs. Despite some growth over the past decade, there is further room for improvement for the PC workforce, particularly at non-NCI-CCs. Cancer center executives endorsed the integration of PC, with greater willingness to invest in PC among NCI-CCs. Resource limitations continue to be a major barrier.

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