Interdisciplinary Perspectives on an Embedded Palliative Oncology Model in Pediatric Cancer Care

Abstract

Outcomes: 1. Compare and contrast perspectives of multidisciplinary providers in regard to an embedded model of pediatric palliative care (PC) in routine cancer care 2. Propose an embedded PC model of care in the learner’s own practice setting Original Research Background: Integration of pediatric palliative care (PPC) into cancer care is recognized as best practice by oncology and pediatrics organizations. However, optimal strategies for integration of PPC within cancer care remain understudied despite growing evidence that suggests embedded models have the potential to improve quality of care. Research Objectives: Embedded models rely on partnerships with interdisciplinary clinicians, whose perspectives regarding this model are not well known. Method(s): We conducted focus groups in an academic pediatric cancer center with groups stratified by discipline (physicians, advance practice providers [APPs], nurses, psychosocial) and by care team (hematologic malignancy, bone marrow transplant, solid tumor, brain tumor). Focus groups were led by trained facilitators and audio-recorded for inductive content analysis to identify clinician perspectives regarding embedded PPC models. Result(s): Across 25 focus groups, 25 physicians, 30 APPs, 71 nurses, and 49 psychosocial clinicians participated. Analysis yielded 3 broad themes: model of care delivery, teamwork, and expectation of responsibilities. Although clinicians identified overlapping themes related to ideal PPC provision and the benefits and challenges inherent to an embedded model, some identified priorities and concepts varied by discipline. Focus groups in all disciplines believed that an embedded PC model would improve access to PPC. Other benefits named included earlier integration (physician, APP), normalization of PPC as an integral aspect of care by patients and families (nurse, psychosocial), collaboration (physician, psychosocial), and communication (APP, psychosocial). Anticipated challenges included inadequate resources (physician, APP, nurse), physician resistance (physician, APP, nurse), and interdisciplinary role confusion (APP, nurse, psychosocial). Conclusion(s): Pediatric oncology interdisciplinary providers recognize the potential value of an embedded model for integration of PPC in the care of children with cancer. Although some concepts and themes overlapped, interdisciplinary clinicians also offered unique perspectives and potential barriers. Implications for Research, Policy, or Practice: These findings highlight the importance of integrating interdisciplinary perspectives when developing an embedded care model to align with priorities of diverse stakeholders. Copyright © 2022