How Do Oncology Residents and Fellows Perceive the Importance of Palliative Care?

Apr 25, 2016

A study published online, ahead of print, February 1, 2016, in the Journal of Oncology Practice (JOP) assessed how medical residents and fellows view the role of palliative care. According to Cancer.Net—the patient-information site of the American Society of Clinical Oncology—palliative care “focuses on preventing, managing, and relieving the symptoms of cancer and the side effects of cancer treatment. It also provides comprehensive support to people living with cancer and their family, friends, and caregivers.”

The study, “Attitudes, Beliefs, and Awareness of Graduate Medical Education Trainees Regarding Palliative Care at a Comprehensive Cancer Center,” carried out at the University of Texas MD Anderson Center, in Houston, assessed perceptions of palliative care through an anonymous online questionnaire given to 170 oncology trainees who completed at least nine months of training in medical, surgical, gynecologic, and radiation oncology. With 78% of trainees responding to the questionnaire, results showed that 92% of respondents viewed palliative care as beneficial to patients and families, 89% believed that it can reduce health costs, 64% believed that it could increase survival, and 74% believe it is important for trainees to have a mandatory rotation in palliative care. Results of the questionnaire also showed that 74% of the trainees would consult palliative care teams when treating patients newly diagnosed with cancer.

According to study coauthor Eduardo Bruera, MD, the researchers were pleased with the results, in light of previous findings showing that medical practitioners are not always enthusiastic about the role of palliative care.

“We found these results very encouraging , and perhaps the most encouraging is the finding that the trainees perceive palliative care as beneficial to patients and families,” said Dr. Bruera. “It’s nice to see that trainees have a positive view of palliative care because this means that wherever they go to practice in the future, they are more likely to take advantage of this service for their patients.”

Perceptions differ based on specialty and clinical exposure to palliative care

The study also revealed that trainees differed in their perceptions of palliative care based on their specialty and clinical experience: A greater percentage of medical, gynecologic, and radiation oncology trainees had an awareness of the role of palliative care (88%, 100%, and 100%, respectively), compared with surgical oncology trainees (61%). In addition, the study found that trainees who had participated in palliative care rotations were more aware of the role of palliative care services, compared with trainees who did not have a palliative care rotation (96%, compared with 74%).

Education and exposure to palliative care changes perceptions among trainees

Studies have shown that palliative care provides many benefits to patients with cancer, including decreasing time spent in the intensive care unit, reducing the number of emergency room visits, and lowering healthcare costs. Importantly, palliative care has also been shown to have a beneficial effect on physical and psychological distress. However, despite the many benefits of palliative care, the United States does not have specific requirements for palliative care training in medical school and residency.

During residency and fellowship at MD Anderson—which has had a dedicated palliative care program since 1999—trainees are frequently exposed to palliative care medicine through directly caring for patients and through palliative care rotations.

According to Dr. Bruera, this exposure might have been a key element in shaping trainees’ positive views about palliative care.

“We believe that trainees’ perceptions of palliative care as something valuable to patents and their family’s well-being is related, to a certain degree, to the fact that many of the trainees are exposed to palliative care consultations during their training,” said Dr. Bruera. “They see what the physicians and nurses from palliative care add to the care of patients and then they internalize this and say, ‘Yes, I will do the same.’”

Eduardo Bruera, MD, is the F.T. McGraw Chair in the Treatment of Cancer and Chair of the Department of Palliative Care and Rehabilitation Medicine at The University of Texas MD Anderson Cancer Center. An ASCO member since 1985, he is the Co-Chair of the Chronic Pain Committee and a member of the Palliative Care in Oncology Symposium Program Committee and the Measures Task Force Committee.


Abstract of the original JOP article.

PDF of the original JOP article.

Wong A, Reddy A, Williams J, et al. Attitudes, beliefs, and awareness of graduate medical education trainees regarding palliative care at a comprehensive cancer center. J Oncol Pract. Epub 2015 Feb 1. 


The Exclusive Coverage series on highlights selected research from JCO, JOP, and JGO, with additional perspective provided by the lead or corresponding author.

@ 2016 American Society of Clinical Oncology

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