Integration of oncology and palliative care (IOP) is recommended by several agencies, including the European Society for Medical Oncology. Given the slow evolution of IOP in practice, several barriers to its implementation may exist. Lack of institutional support is known to be one of the key barriers to IOP. However, institutional recognition towards IOP is less investigated. This was a cross-sectional nationwide survey to clarify the institutional perspectives and attitudes towards IOP in Japan.
We distributed a questionnaire to executives or directors of oncology departments at cancer hospitals on November 2017 and sent a reminder mail later. Since considerable number of patients are receiving cancer treatment at non-designated cancer hospitals (non-DCHs) in Japan, we performed comparison between designated cancer hospitals (DCHs) and non-DCHs. Questionnaire items were developed based on a comprehensive literature review. We conducted descriptive statistics, t-tests and Cochrane-Armitage trend tests where appropriate. To adjust the difference of inpatient beds scale, estimates of non-DCHs were weighted by the distribution of inpatient beds at DCHs.
In total, 399 DCHs and 478 non-DCHs were surveyed, of which 269 (67%) and 259 (54%) responded, respectively. Most cancer hospitals considered their quality of palliative care (PC) services unsatisfying (75% vs. 76% (p = 0.674)), believed that IOP would be beneficial for their patients (85% vs. 89% (p = 0.933)) and did not regard it as costly (13% vs. 18% (p = 0.217)). DCHs had difficulty in recruiting PC physicians and non-DCHs in recruiting not only PC physicians but PC nurses and mental healthcare professionals. Although both were willing to facilitate an early referral to PC services (55% vs. 60% (p = 0.001)), less than 30% of hospitals was planning to increase full-time PC medical staff, inpatient PC beds and funding.
IOP was broadly recognised as beneficial for cancer patients and most institutions were willing to facilitate IOP. However, few institutions were planning to address their limited clinical resources. Strategies, such as the rearrangement of reimbursement systems or education for healthcare professionals, need to be investigated.
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Graduate School of Medicine, Kyoto University.
This research is funded by the Ministry of Health Labor and Welfare in Japan (Health Labor Science Research Grant).
All authors have declared no conflicts of interest.