Hostname: page-component-797576ffbb-6mkhv Total loading time: 0 Render date: 2023-12-05T09:59:09.938Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "useRatesEcommerce": true } hasContentIssue false

Medical oncologists' perception of palliative care programs and the impact of name change to supportive care on communication with patients during the referral process. A qualitative study

Published online by Cambridge University Press:  10 January 2013

Wadih Rhondali
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France
Stephanie Burt
Department of Gastroenterology, Hepatology, & Nutrition, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
Elaine Wittenberg-Lyles
Markey Cancer Center and Department of Communication, University of Kentucky, Lexington, Kentucky
Eduardo Bruera
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
Shalini Dalal*
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
Address correspondence and reprint requests to: Shalini Dalal, Department of Palliative Care and Rehabilitation Medicine, Unit 1414, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030. E-mail:



In a simultaneous care model, patients have concurrent access to both cancer-directed therapies and palliative care. As oncologists play a critical role in determining the need/timing of referral to palliative care programs, their understanding of the service and ability to communicate this with patients is of paramount importance. Our study aimed to examine oncologists' perceptions of the supportive care program at M.D. Anderson Cancer Center, and to determine whether renaming “palliative care” to “supportive care” influenced communication regarding referrals.


This qualitative study used semi-directed interviews, and we analyzed data using grounded theory and qualitative methods.


We interviewed 17 oncologists. Supportive care was perceived as an important time-saving application, and symptom control, transitioning to end-of-life care, family counseling, and improving patients' ability to tolerate cancer therapies were cited as important functions. Although most claimed that early referrals to the service are preferable, oncologists identified several challenges, related to the timing and communication with patients regarding the referral, as well as with the supportive care team after the referral was made. Whereas oncologists stated that the name change had no impact on their referral patterns, the majority supported it, as they perceived their patients preferred it.

Significance of results:

Although the majority of oncologists favorably viewed supportive care, communication barriers were identified, which need further confirmation. Simultaneous care models that effectively incorporate palliative care with cancer treatments need further development.

Original Articles
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)



Ahmedzai, S.H., Costa, A., Blengini, C., et al. (2004). A new international framework for palliative care. European Journal of Cancer, 40, 21922200.Google Scholar
Billings, J.A. & Pantilat, S. (2001). Survey of palliative care programs in United States teaching hospitals. Journal of Palliative Medicine, 4, 309314.Google Scholar
Bruera, E. (2004). The development of a palliative care culture. Journal of Palliative Care, 20, 316319.Google Scholar
Bruera, E. & Hui, D. (2010). Integrating supportive and palliative care in the trajectory of cancer: establishing goals and models of care. Journal of Clinical Oncology, 28, 40134017.Google Scholar
Bruera, E., Neumann, C., Brenneis, C., et al. (2000). Frequency of symptom distress and poor prognostic indicators in palliative cancer patients admitted to a tertiary palliative care unit, hospices, and acute care hospitals. Journal of Palliative Care, 16, 1621.Google Scholar
Cheng, W.W., Willey, J., Palmer, J.L., et al. (2005). Interval between palliative care referral and death among patients treated at a comprehensive cancer center. Journal of Palliative Medicine, 8, 10251032.Google Scholar
Chesebro, J.W. & Borisoff, D.J. (2007). What makes qualitative research qualitative? Qualitative Research Reports in Communication, 8, 314.Google Scholar
Dalal, S., Palla, S., Hui, D., et al. (2011). Association between a name change from palliative to supportive care and the timing of patient referrals at a comprehensive cancer center. Oncologist, 16, 105111.Google Scholar
Detmar, S.B., Muller, M.J., Wever, L.D., et al. (2001). The patient–physician relationship. Patient–physician communication during outpatient palliative treatment visits: An observational study. Journal of the American Medical Association, 285, 13511357.Google Scholar
Elsayem, A., Swint, K., Fisch, M.J., et al. (2004). Palliative care inpatient service in a comprehensive cancer center: clinical and financial outcomes. Journal of Clinical Oncology, 22, 20082014.Google Scholar
Enguidanos, S., Housen, P., Goldstein, R., et al. (2009). Physician and nurse perceptions of a new inpatient palliative care consultation project: Implications for education and training. Journal of Palliative Medicine, 12, 11371142.Google Scholar
Escalante, C.P., Martin, C.G., Elting, L.S., et al. (1997). Medical futility and appropriate medical care in patients whose death is thought to be imminent. Supportive Care in Cancer, 5, 274280.Google Scholar
Fadul, N., Elsayem, A., Palmer, J.L., et al. (2009). Supportive versus palliative care: What's in a name? A survey of medical oncologists and midlevel providers at a comprehensive cancer center. Cancer, 115, 20132021.Google Scholar
Ferris, F.D., Bruera, E., Cherny, N., et al. (2009). Palliative cancer care a decade later: accomplishments, the need, next steps –– from the American Society of Clinical Oncology. Journal of Clinical Oncology, 27, 30523058.Google Scholar
Finlay, E. & Casarett, D. (2009). Making difficult discussions easier: using prognosis to facilitate transitions to hospice. CA, A Cancer Journal for Clinicians, 59, 250263.Google Scholar
Glare, P.A., Auret, K.A., Aggarwal, G., et al. (2003). The interface between palliative medicine and specialists in acute-care hospitals: Boundaries, bridges and challenges. Medical Journal of Australia, 179(Suppl 6), S2931.Google Scholar
Higginson, I.J., Finlay, I.Goodwin, D.M., et al. (2002). Do hospital-based palliative teams improve care for patients or families at the end of life? Journal of Pain and Symptom Management, 23, 96106.Google Scholar
Higginson, I.J., Finlay, I.G., Goodwin, D.M., et al. (2003). Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers? Journal of Pain and Symptom Management, 25, 150168.Google Scholar
Hui, D., Elsayem, A., De la Cruz, M. , et al. (2010a). Availability and integration of palliative care at US cancer centers. Journal of the American Medical Association, 303, 10541061.Google Scholar
Hui, D., Parsons, H., Nguyen, L., et al. (2010b). Timing of palliative care referral and symptom burden in phase 1 cancer patients: A retrospective cohort study. Cancer, 116, 44024409.Google Scholar
Johnson, C.E., Girgis, A., Paul, C.L., et al. (2008). Cancer specialists' palliative care referral practices and perceptions: Results of a national survey. Palliative Medicine, 22, 5157.Google Scholar
Levy, M.H., Back, A., Benedetti, C., et al. (2009). NCCN clinical practice guidelines in oncology: Palliative care. Journal of the National Comprehensive Cancer Network, 7, 436473.Google Scholar
Lindlof, T. R. & Taylor, B.C. (2002). Qualitative Communication Research Methods. Thousand Oaks: CA: Sage.Google Scholar
Loscalzo, M.J. (2008). Palliative care and psychosocial contributions in the ICU. Hematology, 481490.Google Scholar
Meier, D.E. (2010). The development, status, and future of palliative care. In: Palliative Care: Transforming the Care of Serious Illness. Meier, S.I.D. & Hughes, R. (eds.), pp. 376, San Francisco: Jossey-Bass.Google Scholar
Morstad Boldt, A., Yusuf, F., Himelstein, B.P. (2006). Perceptions of the term palliative care. Journal of Palliative Medicine, 9, 11281136.Google Scholar
National Consensus Project (2004). National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care. Pittsburgh: National Consensus Project for Quality Palliative Care.Google Scholar
Onwuegbuzie, A. & Leech, N. (2007). Validity and qualitative research: An oxymoron? Quality & Quantity, 41, 233249.Google Scholar
Osta, B.E., Palmer, J.L., Paraskevopoulos, T., et al. (2008). Interval between first palliative care consult and death in patients diagnosed with advanced cancer at a comprehensive cancer center. Journal of Palliative Medicine, 11, 5157.Google Scholar
Temel, J.S., Greer, J.A., Muzikansky, A., et al. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine, 363, 733742.Google Scholar