MASCC Survey for Palliative Care
Mellar P Davis MD FCCP FAAHPM
MASCC Survey for Palliative Care
• 183 respondents completed at least part of the survey.
• 19 (10%) were from NCI designated cancer centers (15 of
which were comprehensive cancer centers).
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34 (19%) were from ESMO designated centers.
65 (36%) were from other cancer centers.
45 (25%) were from urban hospitals/clinics.
7 (4%) were from rural hospitals/clinics.
11 (6%) were from hospice centers.
MASCC Survey for Palliative Care
The questions scored on a 0-10 scale are reported
both uncoded and arbitrarily coded with scores of 0-3
indicating a negative response, 4-7 a neutral response,
and 8-10 a positive response
Availability
Overall most institutions (83%) had PC available
sometime during the past 10 years, most (93%) are
under the leadership of an M.D., most (91%) have at
least one PC physician on staff, and most (84%) have
dedicated inpatient beds for cancer care
Service Structure
• The most commonly offered PC services are
consultation/mobile team service (72%) and
PC/supportive care clinics (64%), with 52% of
respondents indicating that both services are available
at their institutions
• Only 39% of respondents indicated that dedicated PC
acute care beds were available, and 21% indicated
that there was institution-operated hospice.
Barriers
The barriers to PC access most commonly noted were:
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Limited budget (55%)
Lack of adequately trained PC physicians and nurses (40%)
Poor reimbursement (32%)
5% of respondents identified lack of evidence that PC
improves patient outcome as a barrier
• 4% indicated that a potentially negative impact on the
hospital’s national ranking was a barrier
Effectiveness
• In general respondents indicated that the effectiveness and
quality of their PC program has improved a bit over the past
5 years (median 1 level change in effectiveness and median
2 level change in quality, p<.0001 in both cases; Wilcoxon
signed rank test)
• 2% of centers indicating effectiveness has decreased
• 63% effectiveness has increased
• 3% indicating the quality has decreased
• 69% quality increased
Research
• Respondents were in general agreement that stronger
integration of PC into oncology practice would benefit
patients, and that more research funding should go to PC
(median score of 10 for both questions).
• However only 17% indicated that their institution was likely
(scores 8-10) to increase PC funding.
Increasing Staff
• Respondents were generally neutral regarding future hiring
plans – the median scores for increasing staffing of PC
M.D.s, mid-level providers, and PC nurses were all 5; with
roughly equal numbers of respondents indicating they are
likely (scores 8-10) and unlikely (scores 0-3) to hire each
type of provider.
Palliative Beds
• Respondents tended to have a slight negative bias in terms
of plans to increase the number of PC acute beds at their
institutions – median score was 4
• 49% of respondents indicating they are unlikely (scores 0-3)
to increase the number
• 18% indicating the number is likely (scores 8-10) to be
increased.
Comparisons
• The respondents from the different institution types
answered a number of questions similarly (e.g. program
leadership, several barriers to PC access, effectiveness of
pain management services, need for stronger integration of
PC into oncology practice, the likelihood of increasing PC
nursing staff, and the likelihood of increasing the number of
PC acute beds), however they also differed in a number of
ways
Comparisons
• Cancer centers (NCI, ESMO, other) tended to have had PC
services available sometime during the past 10 years more
frequently than urban hospitals/clinics (85-100% vs 64%,
p=.0002).
• Cancer centers (NCI, ESMO, other) tended to have PC
physicians on staff more frequently than urban
hospitals/clinics (95-100% vs 72%), p=.0004.
Comparisons
• NCI and ESMO designated centers tended to offer PC
services more frequently than urban hospitals/clinics, with
other cancer centers varying between the two (p<.005 for all
services except dedicated PC acute care beds and
institutional-based hospice).
• ESMO designated centers had dedicated PC acute care
beds more frequently than other institutions (76% vs 2432%), p<.0001.
Comparisons
• ESMO designated centers considered poor reimbursement a
barrier to PC access more frequently than other types of
institutions (53% vs 23-32%), p=.02.
• NCI and ESMO designated centers tended to score the
quality of their PC services higher than urban
hospitals/clinics, with other cancer centers between the two
(63-71% of NCI and ESMO designated centers gave scores
of 8-10 versus 53% of other cancer centers, and 33% of
urban hospitals/clinics), p=.001
Comparisons
• Cancer centers (NCI, ESMO, other) tended to score
the likelihood of increasing PC physicians higher than
urban hospitals/clinics (12-25% of cancer centers gave
scores of 0-3 and 35-39% gave scores of 8-10,
compared to 37% and 12%, respectively, for urban
hospitals/clinics), p=.007
Comparisons
• Cancer centers (NCI, ESMO, other) had dedicated
beds for cancer patients more frequently than urban
hospitals/clinics (84-91% vs 69%), p=.01
Comparisons
• Respondents from NCI and ESMO designated centers
tended to answer the survey similarly, however there were
some differences:
• Dedicated PC acute care beds greater with ESMO
• ESMO designated centers scored the current effectiveness
of their pain management programs higher than respondents
from NCI designated centers (79% of ESMO designated
centers scored 8-10 while none gave a score <4, compared
to 56% and 6%, respectively for NCI designated centers),
p=.05
Summary
• Most institutions had PC available sometime during the
past 10 years
• Most commonly offered PC services are
consultation/mobile team service and PC/supportive
care clinics
• Barriers to PC access were limited budget, lack of
adequately trained PC physicians and nurses and poor
reimbursement
Summary
• In general respondents indicated that effectiveness and
quality of their PC program has improved
• Respondents were in general agreement that stronger
integration of PC into oncology practice would benefit
patients, and that more research funding should go to PC
Summary
• Respondents were generally neutral regarding future hiring
plans
• Only 17% indicated that their institution was likely (scores 810) to increase PC funding
• Respondents tended to have a negative bias in terms of
plans to increase the number of PC acute beds