Insufficient knowledge of palliative radiotherapy (PRT) among hospice and palliative medicine (HPM) physicians is thought to be a barrier to the provision of high-quality palliative care.
Objective:
To assess the need for PRT education in HPM fellowship.
Design:
A cross-sectional survey of HPM fellows was conducted in June 2018.
Setting/Subjects:
The survey was distributed to accredited HPM fellowship programs in the United States for distribution to enrolled fellows; 114 fellows responded to the survey.
Results:
Nearly all respondents agreed that the principles of PRT should be taught in HPM fellowship, yet 51% had received no PRT education and 35% had received only one or two hours. Only 25% of respondents rated their working knowledge of PRT as sufficient, 40% felt confident in identifying radiation oncology emergencies or managing radiotherapy side effects, and 52% felt confident in assessing which patients to refer for radiotherapy. More than 75% agreed that were they more knowledgeable about PRT, they would be more likely to consider referral to radiation oncology, to collaborate with radiation oncologists, and to advocate for a short course of treatment based on a patient's prognosis or goals or care. Fellows who received PRT education in fellowship had significantly greater knowledge of and more favorable attitudes toward the use of radiotherapy. This difference was the greatest among fellows who had received at least five hours of PRT education.
Conclusion:
There is a need for PRT education in HPM fellowship. Efforts to address this need may lead to more appropriate utilization of PRT for patients with advanced cancer.
Get full access to this article
View all access options for this article.
References
1.
ZimmermanC, SwamiN, KrzyanowslaM, et al.: Early palliative care for patients with advanced cancer: A cluster-randomized controlled trial. Lancet, 2014; 383:1721–1730.
2.
YennurajalingamS, AtkinsonB, MastersonJ, et al.: The impact of an outpatient palliative care consultation on symptom burden in advanced prostate cancer patients. J Palliat Med, 2012; 15:20–24.
3.
TemelJS, GreerJA, MuzikansyA, et al.: Early palliative care for patients with metastatic non-small cell lung cancer. N Engl J Med, 2010; 363:733–742.
4.
BakitasMA, TostesonTD, LiZ, et al.: Early versus delayed initiation of concurrent palliative oncology care: Patient outcomes in the enable III randomized controlled trial. J Clin Oncol, 2015; 33:1438–1445.
5.
BlackhallLJ, ReadP, StukenborgG, et al.: CARE track for advanced cancer: Impact and timing of an outpatient palliative care clinic. J Palliat Med, 2016; 19:57–63.
6.
BandieriE, SichettiD, RomeroM, et al.: Impact of early access to a palliative/supportive care intervention on pain management in patients with cancer. Ann Oncol, 2012; 23:2016–2020.
7.
TemelJS, GreerJA, El-JawahriA, et al.: Effects of early integrated palliative care in patients with lung and GI cancer: A randomized clinical trial. J Clin Oncol, 2017; 35:834–841.
8.
VanbutseleG, PardonK, Van BelleS, et al.: Effect of early and systematic integration of palliative care in patients with advanced cancer: A randomised controlled trial. Lancet Oncol, 2018; 19:394–404.
9.
Institute of Medicine (IOM): Delivering high-quality cancer care: Charting a new course for a system in crisis. Washington, DC: National Academies Press, 2013.
10.
GormanD, BalboniT, TaylorA, KrishnanM: The Supportive and Palliative Radiation Oncology service: A dedicated model for palliative radiation oncology care. J Adv Pract Oncol, 2014; 6:135–140.
11.
McCloskeySA, TaoML, RoseCM, et al.: National survey of perspectives of palliative radiation therapy: Role, barriers, and needs. Cancer J, 2007; 13:130–137.
12.
MorrisL, GorayskiP, TurnerS: Targeting general practitioners: Prospective outcomes of a national education program in radiation oncology. J Med Imaging Radiat Oncol, 2018; 62:270–275.
13.
BarnesEA, HansonJ, NeumannCM, et al.: Communication between primary care physicians and radiation oncologists regarding patients with cancer treated with palliative radiotherapy. J Clin Oncol, 2000; 18:2902–2907.
14.
BerrangT, SamantR: Palliative radiotherapy knowledge among community family physicians and nurses. J Cancer Educ, 2008; 23:156–160.
15.
SamantRS, FitzgibbonE, MengJ, et al.: Family physicians' perspectives regarding palliative radiotherapy. Radiother Oncol, 2006; 78:101–106.
16.
LutzS, SpenceC, ChowE, et al.: Survey on use of palliative radiotherapy in hospice care. J Clin Oncol, 2004; 22:3581–3586.
MartinEJ, JonesJA: Characterizing palliative radiotherapy education in hospice and palliative medicine fellowship: A survey of fellowship program directors. J Palliat Med, 2019; 23:275–279.
20.
ShaverdianN, YooSM, CookR, et al.: Gaps in radiation therapy awareness: Results from an educational multi-institutional survey of US internal medicine residents. Int J Radiat Oncol, 2017; 98:1153–1161.
21.
TuckerTL, SamantRS, FitzgibbonEJ: Knowledge and utilization of palliative radiotherapy by pediatric oncologists. Curr Oncol, 2010; 17:48–55.
22.
OlsonRA, LengocS, TyldesleyS, et al.: Relationships between family physicians' referral for palliative radiotherapy, knowledge of indications for radiotherapy, and prior training: A survey of rural and urban family physicians. Radiat Oncol, 2012; 7:73.
23.
MattesMD, SmallW, VapiwalaN: Out of the basement and into the classroom: Pathways for expanding the role of radiation oncologists in medical student education. J Am Coll Radiol, 2018; 15:1620–1623.
24.
ZaorskyNG, ShaikhT, HandorfE, et al.: What are medical students in the united states learning about radiation oncology? Results of a multi-institutional survey. Int J Radiat Oncol Biol Phys, 2016; 94:235–242.
25.
NeeleyBC, GoldenDW, BrowerJV, et al.: Student perspectives on oncology curricula at United States medical schools. J Cancer Educ, 2019; 34:56–58.
26.
DennisKE, DuncanG: Radiation oncology in undergraduate medical education: A literature review. Int J Radiat Oncol Biol Phys, 2010; 76:649–655.
27.
FairchildA, GhoshS, BakerJ: Patterns of referral and knowledge of palliative radiotherapy in Alberta. Can Fam Physician, 2012; 58:e113–e122.
28.
McDonaldR, ChowE, RowbottomL, et al.: Quality of life after palliative radiotherapy in bone metastases: A literature review. J Bone Oncol, 2015; 4:24–31.
29.
LutzST, JonesJ, ChowE: Role of radiation therapy in palliative care of the patient with cancer. J Clin Oncol, 2014; 32:2913–2919.
30.
JonesJA, LutzST, ChowE, JohnstonePA: Palliative radiotherapy at the end of life: A critical review. CA Cancer J Clin, 2014; 64:295–310.
31.
WesthoffPG, de GraeffA, MonninkhofEM, et al.: Quality of life in relation to pain response to radiation therapy for painful bone metastases. Int J Radiat Oncol Biol Phys, 2015; 93:694–701.
32.
DelaneyG, JacobS, FeatherstoneC, et al.: The role of radiotherapy in cancer treatment. Cancer, 2005; 104:1129–1137.
33.
MurphyJD, NelsonLM, ChangDT, et al.: Patterns of care in palliative radiotherapy: A population-based study. J Oncol Pract, 2013; 9:e220–e227.
34.
BekelmanJE, EpsteinAJ, EmanuelEJ: Single- vs multiple-fraction radiotherapy for bone metastases from prostate cancer. JAMA, 2013; 310:1501–1502.
35.
SkameneS, AgarwalI, MakarM, et al.: Impact of a dedicated palliative radiation oncology service on the use of single fraction and hypofractionated radiation therapy among patients with bone metastases. Ann Palliat Med, 2018; 7:186–191.
36.
FairchildA, BarnesE, GhoshS, et al.: International patterns of practice in palliative radiotherapy for painful bone metastases: Evidence-based practice?. Int J Radiat Oncol Biol Phys, 2009; 75:1501–1510.
37.
MeeuseJJ, van der LindenYM, van TienhovenG, et al.: Efficacy of radiotherapy for painful bone metastases during the last 12 weeks of life: Results from the Dutch Bone Metastasis Study. Cancer, 2010; 116:2716–2725.
38.
RutterCE, YuJB, WilsonLD, et al.: Assessment of national practice for palliative radiation therapy for bone metastases suggests marked underutilization of single-fraction regimens in the United States. Int J Radiat Oncol, 2015; 91:548–555.
39.
GuadagnoloBA, LiaoK-P, EltingL, et al.: Use of radiation therapy in the last 30 days of life among a large population-based cohort of elderly patients in the United States. J Clin Oncol, 2013; 31:80–87.
RopeRW, PivertKA, ParkerMG, et al.: Education in nephrology fellowship: A survey-based needs assessment. J Am Soc Nephrol, 2017; 28:1983–1990.
42.
ChildersJW, ArnoldRM: “I feel uncomfortable ‘calling a patient out’”: Educational needs of palliative medicine fellows in managing opioid misuse. J Pain Symptom Manage, 2012; 43:253–260.
43.
CarmodyS, MeierD, BillingsJA, et al.: Training of palliative medicine fellows: A report from the field. J Palliat Med, 2005; 8:1005–1015.
44.
ChoiBCK, PakAWP: A catalog of biases in questionnaires. Prev Chronic Dis, 2005; 2:A13.
45.
AlthubaitiA: Information bias in health research: Definition, pitfalls, and adjustment methods. J Multidiscip Healthc, 2016; 9:211–217.
46.
MartinEJ, NalawadeVV, MurphyJD, et al.: Incorporating palliative radiotherapy education into hospice and palliative medicine fellowship training: A feasibility study. Ann Palliat Med, 2019; [Epub ahead of print]; DOI: 10.21037/apm.2019.04.02.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
