Early palliative care: Attitudes and opinions of palliative care physicians.
Bibliographic record
Abstract
e21669 Background: Early palliative care (EPC) is increasingly recommended. Recent studies have described oncologists’ barriers to early referral to palliative care. Predictors of early referral included oncologists’ satisfaction with availability of palliative services and palliative services’ acceptance of patients who were receiving chemotherapy. Methods: Palliative care physicians identified by the Canadian Society of Palliative Care Physicians were invited to complete a survey evaluating their attitudes and opinions about EPC by mail and email. Logistic regression was performed on a sample of 257 specialized palliative care (SPC) physicians, (receiving referrals from other physicians) to determine factors associated with receiving early referrals. Backwards likelihood ratio was used to select covariates for the multivariate model (entry p ≤ 0.2). Results: The response rate was 71% (531/747); 48% (257/531) were SPC physicians, the majority of whom (84.4%; 216/256) provide > 50% of their care for cancer patients. The large majority of SPC physicians (93.9%; 229/244) reported that referral to palliative care should ideally be early (at prognosis > 6 months, upon diagnosis of cancer/life-limiting illness, or upon diagnosis of incurable cancer). However, only 20.5% (52/254) reported that the average survival for patients referred to them was > 6 months, and 33.8% (87/256) reported having insufficient resources to provide EPC. Factors associated with receiving early referrals included having a postgraduate degree (OR 2.5, 95% CI 1.1-5.5); providing care mainly for non-cancer patients (4.0, 1.3-12.3); and female sex (2.7, 1.2-6.2). Those agreeing that patients should have stopped all chemotherapy before palliative care referral were less likely to receive early referrals (OR 0.34, 95% CI 0.16-0.73). Conclusions: Although almost all SPC physicians favor EPC, the majority do not receive early referrals. Barriers to earlier integration of palliative care into oncology care appear to be at the receiving as well as the referring end, and include lack of resources as well as a prevailing attitude by a small minority that patients should have stopped all chemotherapy before referral.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.012 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".