IDDF2020-ABS-0176 Clinician experience and attitudes to palliative care in patients with HCC – an Australia-wide survey. (18th November 2020)

• Record Type: Journal Article
• Authors: Sabih, Abdul-Hamid; Lim, Lynn; Cigolini, Maria; Strasser, Simone I; Liu, Ken
• Is Part Of: Gut. Volume 69(2020)Supplement 2
• Page Start: A86
• Page End: A86
• Publication Date: 2020-11-18
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2020-IDDF.162
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Background: Palliative care (PC) service involvement in HCC patients is suboptimal. Little is known about clinician experience and attitudes towards PC in HCC, which formed the aim of our study. Methods: A nationwide survey of consultants/trainees was conducted through the Gastroenterological Society of Australia. Clinician and practice demographics, experience and attitudes towards PC use in HCC patients were collected. Results: 161 respondents participated with representation from all states/territories (61% male, 94% gastroenterologist/hepatologist). Most worked in public metropolitan hospitals (79%) with weekly multidisciplinary tumour board meetings (MDTBM) (59%) and had no formal PC training (71%). MDTBM with PC team attendance was reported by 11%, although 77% thought this would be useful. Both rates of PC referral and perceived usefulness of PC increased incrementally from Barcelona Clinic Liver Cancer (BCLC) 0/A to BCLC D patients but were not universal even in advanced (46%)/terminal(87%) stages. Those with prior PC training were more likely to refer BCLC 0/A patients for early PC ( P =0.01). Referral rates for outpatient PC were higher in respondents who attended MDTBM with PC present ( P <0.05 for all BCLC stages). Common reasons for referral were: end-of-life care (93%), pain (63%), treatment side-effects (21%) and psychological symptoms (21%). Most acknowledged PC discussions with patients occurred too late (61%) while the best time was thought to be at diagnosis of an incurable disease (61%). PC service was rated good/very good by 70% for outpatients and 81% for inpatients and 81% thought the referral process was easy. Major barriers identified to PC referral were: negative associations with the term 'PC' (83%), patient/family lack of acceptance (82%/77%), cultural factors (74%) and insufficient time in clinic (70%). The majority (78%) thought patients would be more accepting of PC if the name was changed to 'supportive care'. Conclusions: PC referral for HCC patients occurs late and is not universal even in late-stage disease. Barriers to PC referral were not related to the quality of/access to PC services but rather to clinician perception/belief that PC would not be accepted by patients and their families.