Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-25T07:25:50.041Z Has data issue: false hasContentIssue false
  • English
  • Français

Palliative care management of head and neck cancer patients among otolaryngology surgeons: a novel national survey assessing knowledge, decision making, perceived confidence and training in the UK

Published online by Cambridge University Press:  02 May 2022

A Lotfallah ,
S Al-Hity Open the ORCID record for S Al-Hity [Opens in a new window] ,
J Limbrick ,
N Khan  and
A Darr
A Lotfallah*
Affiliation:
ENT Department, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, Wolverhampton, UK
S Al-Hity
Affiliation:
ENT Department, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, Wolverhampton, UK
J Limbrick
Affiliation:
ENT Department, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, Wolverhampton, UK
N Khan
Affiliation:
John Taylor Hospice, Birmingham, UK
A Darr
Affiliation:
ENT Department, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, Wolverhampton, UK
*
Author for correspondence: Mr A Lotfallah, ENT Department, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton Road, WolverhamptonWV10 0QP, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Management of head and neck cancer patients provides unique challenges. Palliation serves to optimise quality-of-life by alleviating suffering and maintaining dignity. Prompt recognition and management of suffering is paramount to achieving this. This study aimed to assess perceived confidence, knowledge and adequacy of palliative training among UK-based otolaryngologists.

Method

Eight multiple-choice questions developed by five palliative care consultants via the Delphi method were distributed over five weeks. Knowledge, perceived confidence and palliative exposure among middle-grade and consultant otolaryngologists were assessed, alongside training deficits.

Results

Overall, 145 responses were collated from middle-grade (n = 88, 60.7 per cent) and consultant (n = 57, 39.3 per cent) otolaryngologists. The mean knowledge score was 5 out of 10, with 22.1 per cent (n = 32) stating confidence in palliative management. The overwhelming majority (n = 129, 88.9 per cent) advocated further training.

Conclusion

A broad understanding of palliative care, alongside appropriate specialist involvement, is key in meeting the clinical needs of palliative patients. Curriculum integration of educational modalities such as simulation and online training may optimise palliative care.

Keywords

Palliative CareHead And Neck Cancer Squamous Cell CarcinomaTraining ProgramsCurriculum
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 9 , September 2022 , pp. 799 - 808
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Mr A Lotfallah takes responsibility for the integrity of the content of the paper

Presented as a poster at The Midland Institute of Otorhinolaryngology and South Western Laryngological Association Joint Summer Meeting, 11 May 2021, online.

References

Johnson, DE, Burtness, B, Leemans, CR, Lui, VWY, Bauman, JE, Grandis, JR et al. Head and neck squamous cell carcinoma. Nat Rev Dis Primers 2020;6:92CrossRefGoogle ScholarPubMed
Cancer Research UK. Head and neck cancers statistics. In: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/head-and-neck-cancers#heading-Zero [20 March 2021]Google Scholar
Schenker, Y, Arnold, RM, Baumen, JE, Heron, DE, Johnson, JT. An enhanced role for palliative care in the multidisciplinary approach to high-risk head and neck cancer. Cancer 2016;122:340–3CrossRefGoogle ScholarPubMed
World Health Organisation. Palliative Care. In: https://www.who.int/health-topics/palliative-care [20 March 2021]Google Scholar
Cocks, H, Ah-See, K, Capel, M, Taylor, P. Palliative and supportive care in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016;130:S198–207CrossRefGoogle ScholarPubMed
Davis, J, Spraggs, P, Murray, C, Bussey, M. Otolaryngology Curriculum: The Intercollegiate Surgical Curriculum Programme. In: https://www.iscp.ac.uk/media/1106/otolaryngology-curriculum-aug-2021-approved-oct-20.pdf [5 April 2021]Google Scholar
Roberts, K. 2021. Cancer services during COVID-19: 40,000 fewer people starting treatment - Cancer Research UK - Cancer news. Cancer Research UK - Science blog. In: https://news.cancerresearchuk.org/2021/02/02/cancer-services-during-covid-19-40000-fewer-people-starting-treatment [5 April 2021]Google Scholar
Maringe, C, Spicer, J, Morris, M, Purushotham, A, Nolte, E, Sullivan, R et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. Lancet 2020;21:1023–34CrossRefGoogle ScholarPubMed
Vose, JM. Delay in cancer screening and diagnosis during the COVID-19 pandemic: what is the cost? Oncology (Williston Park) 2020;34:343CrossRefGoogle ScholarPubMed
De Vincentiis, L, Carr, RA, Mariani, MP, Ferrara, G. Cancer diagnostic rates during the 2020 ‘lockdown’, due to COVID-19 pandemic, compared with the 2018-2019: an audit study from cellular pathology. J Clin Pathol 2021;74:187–9CrossRefGoogle ScholarPubMed
Begbie, F, Douglas, C, Finlay, F, Montgomery, J. Palliative intent treatment for head and neck cancer: an analysis of practice and outcomes. J Laryngol Otol 2019;133:313–17CrossRefGoogle ScholarPubMed
Simcock, R, Simo, R. Follow-up and survivorship in head and neck cancer. Clin Oncol (R Coll Radiol) 2016;28:451–8CrossRefGoogle ScholarPubMed
NICE. Recommendations: care of dying adults in the last days of life: guidance, 2021. In: https://www.nice.org.uk/guidance/ng31/chapter/Recommendations#pharmacological-interventions [8 April 2021]Google Scholar
Charlton, S, Hooke, M, Armstrong, R, Vandenberg, B, Hardy, J. Catastrophic events in terminal patients. 2013. In: https://www.palliativedrugs.com/download/141217_catastrophic_event_31_10_14_2percent5B1percent5D.pdf [8 April 2021]Google Scholar
Harris, D, Noble, S. Management of terminal hemorrhage in patients with advanced cancer: a systematic literature review. J Pain Symptom Manage 2009;38:913–27CrossRefGoogle ScholarPubMed
Fritz, Z, Slowther, A, Perkins, GD. Resuscitation policy should focus on the patient, not the decision. BMJ 2017;356:j813CrossRefGoogle Scholar
Compassion in Dying. What rights does an attorney have under a Lasting Power of Attorney for Health and Welfare?: 2021. In: https://compassionindying.org.uk/making-decisions-and-planning-your-care/planning-ahead/lasting-power-attorney/attorney-rights/ [15 April 2021]Google Scholar
Ballou, JH, Brasel, KJ. Surgical palliative care education. Surg Clin North Am 2019;99:1037–49CrossRefGoogle ScholarPubMed
Pernar, LIM, Peyre, SE, Smink, DS, Block, SD, Cooper, ZR. Feasibility and impact of a case-based palliative care workshop for general surgery residents. J Am Coll Surg 2012;214:231–6CrossRefGoogle ScholarPubMed
Harden, K, Price, D, Duffy, E, Galunas, L, Rodgers, C. Palliative care: improving nursing knowledge, attitudes, and behaviors. Clin J Oncol Nurs 2017;21:E232–8CrossRefGoogle Scholar
Thrane, SE. Online palliative and end-of-life care education for undergraduate nurses. J Prof Nurs 2020;36:42–6CrossRefGoogle ScholarPubMed
Bearman, M, Nestel, D, Andreatta, P. Oxford Textbook of Medical Education, 1st edn. Oxford: Oxford University Press, 2013Google Scholar
Goldonowicz, JM, Runyon, MS, Bullard, MJ. Palliative care in the emergency department: an educational investigation and intervention. BMC Palliat Care 2018;17:43CrossRefGoogle ScholarPubMed
Kirkpatrick, AJ, Cantrell, MA, Smeltzer, SC. Palliative care knowledge and self-awareness in active and observing undergraduate nursing students after end-of-life simulation. Int J Palliat Nurs 2020;26:133–42CrossRefGoogle ScholarPubMed
Renton, K, Quinton, H, Mayer, AT. Educational impact of paediatric palliative simulation study days. BMJ Support Palliat Care 2017;7:88–93CrossRefGoogle ScholarPubMed