The gatekeepers of palliative care: A systematic mixed studies review of oncologists' perceptions and attitudes towards palliative care for advanced cancer patients
Bibliographic record
Abstract
Background: Early palliative care has been shown to optimize a variety of different aspects of cancer care including symptom management, psychosocial support, spiritual care and decisionmaking.Despite these benefits and the increasing availability of palliative care services, the majority of cancer patients are only referred to palliative care in the late, terminal stages of disease.As the gatekeepers of palliative care, oncologists can offer a wealth of insight into why cancer patients are not being referred as early and as often as they should.Objectives: The main purpose of this thesis is to explore oncologists' perceptions and attitudes toward palliative care in order to better understand the physician-level barriers to early palliative care referral.Methods: This thesis contains of two related manuscripts.The first manuscript consists of a systematic mixed studies review and narrative synthesis of the current literature investigating oncologists' perceptions and attitudes toward palliative care for cancer patients.The second manuscript expands on the first manuscript by examining oncologist-driven models of palliative care referral from an ethical perspective.Results: Twenty-one studies met the inclusion criteria for the systematic review.Themes describing oncologists' perceptions of palliative care include: 1) the value of palliative care, 2) the timing of palliative care referral, 3) the role of the palliative care provider, 4) the coordination of care, 5) the philosophy of care and 6) the impact of palliative care referral on the patient.The ethical analysis found that, owing to oncologists' heterogeneous perceptions of palliative care, the current oncologist-driven models of palliative care referral are unethical and need to be improved.Conclusions: The delays in referral to palliative care are likely due to the conflicting professional cultures of oncology and palliative care, as well as a Dr. Emmanelle Belanger and Dr. Eugene Bereza.I extend a tremendous thanks to both of them for taking the time to share their expertise with me and provide me with feedback, guidance and inspiration.
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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 | 0.060 | 0.194 |
| Meta-epidemiology (narrow) | 0.001 | 0.002 |
| Meta-epidemiology (broad) | 0.004 | 0.005 |
| Bibliometrics | 0.006 | 0.008 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
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".