Physicians' Perspectives on Palliative Care for Patients With End-Stage Liver Disease: A National Survey Study.
Attitude
Cross-Sectional Studies
End Stage Liver Disease
/ psychology
Female
Gastroenterologists
/ psychology
Humans
Intersectoral Collaboration
Liver Transplantation
Male
Palliative Care
/ psychology
Referral and Consultation
/ statistics & numerical data
Surveys and Questionnaires
/ statistics & numerical data
Time Factors
United States
Waiting Lists
Journal
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
ISSN: 1527-6473
Titre abrégé: Liver Transpl
Pays: United States
ID NLM: 100909185
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
17
01
2019
accepted:
24
03
2019
pubmed:
10
4
2019
medline:
11
8
2020
entrez:
10
4
2019
Statut:
ppublish
Résumé
Specialty palliative care (PC) is underused for patients with end-stage liver disease (ESLD). We sought to examine attitudes of hepatologists and gastroenterologists about PC for patients with ESLD. We conducted a cross-sectional survey of these specialists who provide care to patients with ESLD. Participants were recruited from the American Association for the Study of Liver Diseases membership directory. Using a questionnaire adapted from prior studies, we examined physicians' attitudes about PC and whether these attitudes varied based on patients' candidacy for liver transplantation. We identified predictors of physicians' attitudes about PC using linear regression. Approximately one-third of eligible physicians (396/1236, 32%) completed the survey. Most (95%) believed that centers providing care to patients with ESLD should have PC services, and 86% trusted PC clinicians to care for their patients. Only a minority reported collaborating frequently with inpatient (32%) or outpatient (11%) PC services. Most believed that when patients hear the term PC, they feel scared (94%) and anxious (87%). Most (83%) believed that patients would think nothing more could be done for their underlying disease if a PC referral was suggested. Physicians who believed that ESLD is a terminal condition (B = 1.09; P = 0.006) reported more positive attitudes about PC. Conversely, physicians with negative perceptions of PC for transplant candidates (B = -0.22; standard error = 0.05; P < 0.001) reported more negative attitudes toward PC. In conclusion, although most hepatologists and gastroenterologists believe that patients with ESLD should have access to PC, they reported rarely collaborating with PC teams and had substantial concerns about patients' perceptions of PC. Interventions are needed to overcome misperceptions of PC and to promote collaboration with PC clinicians for patients with ESLD.
Identifiants
pubmed: 30963669
doi: 10.1002/lt.25469
pmc: PMC6529275
mid: NIHMS1022281
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
859-869Subventions
Organisme : NCI NIH HHS
ID : K12 CA087723
Pays : United States
Organisme : NIDDK NIH HHS
ID : K24 DK078772
Pays : United States
Informations de copyright
Copyright © 2019 by the American Association for the Study of Liver Diseases.
Références
J Am Geriatr Soc. 2000 May;48(S1):S122-30
pubmed: 10809465
Cancer. 2003 Dec 1;98(11):2502-10
pubmed: 14635087
J Hepatol. 2006 Jan;44(1):217-31
pubmed: 16298014
Qual Health Res. 2006 Jan;16(1):119-36
pubmed: 16317180
Crit Care Med. 2006 Oct;34(10):2547-53
pubmed: 16932230
Cancer. 2009 May 1;115(9):2013-21
pubmed: 19235253
JAMA. 2009 Aug 19;302(7):741-9
pubmed: 19690306
Qual Health Res. 2010 Feb;20(2):182-96
pubmed: 19955227
N Engl J Med. 2010 Aug 19;363(8):733-42
pubmed: 20818875
Pediatrics. 2012 Apr;129(4):e975-82
pubmed: 22392177
Psychooncology. 2013 Apr;22(4):940-6
pubmed: 22451082
Chest. 2013 Mar;143(3):736-743
pubmed: 22922517
Palliat Support Care. 2013 Oct;11(5):397-404
pubmed: 23302500
J Am Coll Cardiol. 2013 Oct 15;62(16):e147-239
pubmed: 23747642
Clin Gastroenterol Hepatol. 2014 Apr;12(4):692-8
pubmed: 23978345
J Am Heart Assoc. 2014 Jan 02;3(1):e000544
pubmed: 24385453
BMJ Support Palliat Care. 2016 Mar;6(1):66-74
pubmed: 24916198
J Clin Gastroenterol. 2015 Sep;49(8):690-6
pubmed: 25291348
J Oncol Pract. 2015 Mar;11(2):e230-8
pubmed: 25784580
J Clin Oncol. 2015 May 1;33(13):1446-52
pubmed: 25800762
Kidney Int. 2015 Sep;88(3):447-59
pubmed: 25923985
J Card Fail. 2015 Jun;21(6):519-34
pubmed: 25953697
Oncologist. 2015 Nov;20(11):1326-32
pubmed: 26417037
JAMA Intern Med. 2016 Feb;176(2):263-5
pubmed: 26720644
CMAJ. 2016 Jul 12;188(10):E217-E227
pubmed: 27091801
J Palliat Med. 2016 Aug;19(8):836-41
pubmed: 27092870
Natl Vital Stat Rep. 2016 Jun;65(4):1-122
pubmed: 27378572
J Clin Oncol. 2016 Sep 10;34(26):3126-32
pubmed: 27400944
World J Transplant. 2016 Sep 24;6(3):594-8
pubmed: 27683638
JAMA. 2016 Nov 22;316(20):2094-2103
pubmed: 27893130
Clin Gastroenterol Hepatol. 2017 Oct;15(10):1612-1619.e4
pubmed: 28179192
Ann Hepatol. 2017 May - Jun 2017;16(3):395-401
pubmed: 28425409
Am J Hosp Palliat Care. 2018 Mar;35(3):431-439
pubmed: 28631493
Clin J Am Soc Nephrol. 2017 Jul 7;12(7):1085-1089
pubmed: 28655708
Hepatology. 2017 Nov;66(5):1585-1591
pubmed: 28660622
J Am Coll Cardiol. 2017 Jul 18;70(3):331-341
pubmed: 28705314
Frontline Gastroenterol. 2016 Jan;7(1):4-9
pubmed: 28839829
J Clin Oncol. 2017 Nov 10;35(32):3714-3721
pubmed: 28926288
Liver Int. 2018 May;38(5):768-775
pubmed: 29112338
Hepatology. 2018 May;67(5):2025-2040
pubmed: 29251778
Cancer. 2018 Dec 1;124(23):4556-4566
pubmed: 30289980