COMFORT Survey: A comparison of the comfort level of hematologic and solid tumor oncology specialists with serious illness conversations.

Abstract

12102 Background: Serious illness conversations (SICs) are essential in aligning medical care with the values and goals of patients with advanced cancer. It is unclear if hematologic and solid tumors specialists (i.e., physicians [MDs] and advanced practice providers [APPs]) differ in their comfort level with SICs, which may drive end-of-life care outcomes. We compared the comfort level with SICs between hematologic and solid tumor specialists and examined contributing factors. Methods: We surveyed 186 hematology and 186 solid tumor specialists at MD Anderson Cancer Center. The 64-question survey examined their comfort with SICs under 5 domains (Transitions of Care [TOC, primary outcome], Dying Process [EOL], Prognosis, Goals, Advance Care Planning [ACP]). Responses were rated from 0 (extremely uncomfortable) to 10 (extremely comfortable). The TOC domain included 4 questions (i.e., stopping cancer therapy / transfusions / artificial nutrition and recommending hospice). We compared groups using simple linear and multivariable models accounting for specialist demographics. Results: 245 specialists completed this survey, with a response rate of 66%. Hematologic and solid tumor specialists both reported high comfort with TOC (7.0 [2.4] vs 7.1 [2.2]), with no significant difference between groups (mean difference [95% CI]: 0.1 [-0.5, 0.7]; P=0.78). In univariate analysis, APPs were significantly less comfortable with TOC than MDs among both hematologic (2 [1.2, 2.8]; P<0.0001) and solid tumor specialists (1.4 [0.7, 2.2]; P=0.001). In multivariate analysis, APPs remained the only significant variable associated with less comfort with TOC in hematologic (1.5 [0.4, 2.7]) and solid tumor groups (1.2 [0.2, 2.1]). Similarly, we found no significant difference between hematologic and solid tumor specialists in comfort level with the other 4 SIC domains and observed significant differences between APPs and MDs (Table). Conclusions: Both hematologic and solid tumor specialists reported high levels of comfort with SIC; however, APPs were significantly less comfortable. Given that APPs are increasingly involved in SIC, our study underscores the need to provide more training and support for APPs. Self-reported comfort levels for 5 SIC domains. Mean [SD] MD vs. APP Mean differences [95% CI]; p-value Domains Solid MD Solid APP Heme MD Heme APP Heme Solid TOC 7.8 [1.7] 6.4 [2.5] 8.1 [1.9] 6.1 [2.4] 2 [1.2,2.8]; <.0001 1.4 [0.7,2.2]; 0.001 Prognosis 8.5 [1.4] 7.1 [2.1] 8.6 [1.8] 6.8 [1.8] 1.9 [1.2,2.5]; <.0001 1.4 [0.8,2]; <.0001 Goals 8.5 [1.2] 7.8 [1.7] 8.9 [1.4] 7.5 [1.9] 1.4 [0.8,2]; <.0001 0.7 [0.1,1.2]; 0.09 EOL 7.9 [1.9] 6.3 [2.6] 8 [2.3] 6.2 [2.8] 1.8 [0.9,2.7]; 0.0005 1.6 [0.8,2.4]; 0.0009 ACP 8.6 [1.2] 7.2 [2.5] 9.1 [1.1] 7.3 [2.4] 1.7 [1,2.5]; <.0001 1.4 [0.7,2.1]; 0.0006