Article Text

Download PDFPDF
Gynecologic Oncologist Views Influencing Referral to Outpatient Specialty Palliative Care
  1. Casey M. Hay, MD*,
  2. Carolyn Lefkowits, MD,,
  3. Megan Crowley-Matoka, PhD§,
  4. Marie A. Bakitas, DNSc,
  5. Leslie H. Clark, MD,
  6. Linda R. Duska, MD#,
  7. Renata R. Urban, MD**,
  8. Lee-may Chen, MD††,
  9. Stephanie L. Creasy, BA‡‡ and
  10. Yael Schenker, MD§§
  1. *Division of Gynecologic Oncology, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA;
  2. Division of Gynecologic Oncology and
  3. Palliative Care, Department of Medicine, University of Colorado Denver, Denver, CO;
  4. §Medical Education/Medical Humanities and Bioethics/Anthropology, Northwestern University, Chicago, IL;
  5. Department of Medicine, School of Nursing, University of Alabama at Birmingham, Birmingham, AL;
  6. Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC;
  7. #Division of Gynecologic Oncology, University of Virginia School of Medicine, Charlottesville, VA;
  8. **Division of Gynecologic Oncology, University of Washington, Seattle, WA;
  9. ††University of California Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; and
  10. ‡‡Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health; and
  11. §§Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA.
  1. Address correspondence and reprint requests to Casey M. Hay, MD, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, 300 Halket St, Pittsburgh, PA 15213. E-mail:


Objective Early specialty palliative care is underused for patients with advanced gynecologic malignancies. We sought to understand how gynecologic oncologists' views influence outpatient specialty palliative care referral to help inform strategies for improvement.

Methods/Materials We conducted a qualitative interview study at 6 National Cancer Institute–designated cancer centers with well-established outpatient palliative care services. Between September 2015 and March 2016, 34 gynecologic oncologists participated in semistructured telephone interviews focused on attitudes, experiences, and preferences related to outpatient specialty palliative care. A multidisciplinary team analyzed transcripts using constant comparative methods to inductively develop a coding framework. Through an iterative, analytic process, codes were classified, grouped, and refined into themes.

Results Mean (SD) participant age was 47 (10) years. Mean (SD) interview length was 25 (7) minutes. Three main themes emerged regarding how gynecologic oncologists view outpatient specialty palliative care: (1) long-term relationships with patients is a unique and defining aspect of gynecologic oncology that influences referral, (2) gynecologic oncologists value palliative care clinicians' communication skills and third-party perspective to increase prognostic awareness and help negotiate differences between patient preferences and physician recommendation, and (3) gynecologic oncologists prefer specialty palliative care services embedded within gynecologic oncology clinics.

Conclusions Gynecologic oncologists value longitudinal relationships with patients and use specialty palliative care to negotiate conflict surrounding prognostic awareness or the treatment plan. Embedding specialty palliative care within gynecologic oncology clinics may promote communication between clinicians and facilitate gynecologic oncologist involvement throughout the illness course.

  • Palliative care
  • Qualitative research
  • Early integration

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under award number KL2TR000146.

  • Dr Schenker has received grant funds from the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number KL2TR000146 during the conduct of this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The remaining authors listed on this manuscript have no conflicts of interest to disclose.

  • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (