Table 4.

Gynecologic oncologists value specialty palliative care clinicians’ communication skills and third-party perspective as a means to increase prognostic awareness and help negotiate differences between patient preferences and physician recommendations.

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Communication skills and emotional support	One of the best things I think they do is communication. Really the time that they spend communicating with the families to kind of bring everybody on the same page is something that is a skill set that most GYN oncologists don’t have and also don’t have time to do. You know patients that are having a lot of stress too, maybe don’t have good social support, that they can kind of help them work through how to talk with their family and all that kind of stuff, I feel like that’s more part of their training than mine. And then patients who are having a lot of difficulty with dealing with the sort of the logistics around how they’re going to talk to their family members, oftentimes, especially at the point at which it’s clear that their diagnosis, they no longer have a curable disease, so family issues, emotional distress, issues with helping them address death and dying both with themselves and a lot of times with their families.
Third-party clinician used to increase prognostic awareness	If you have a patient who is really struggling, to hear it from a different person’s perspective I think can be good. And then by engaging the palliative care folks, like I said before, you have multiple people talking about the same issues, so it tends to reinforce in the patient that it is important for them to understand where their disease is and that they may want to start thinking about end of life issues. If they seem like they really need additional people to talk more, or they seem maybe not as understanding of their prognosis sometimes if they would listen to a second provider coming from a different angle I think it’s helpful to get them that information
Helps negotiate patient-physician differences	Patients who are referred to palliative care, and I can think of several examples of this, are usually patients who, either by myself or my nurse practitioner, were breached about hospice or were having pain control issues with their existing support system and we were trying to change their pattern of care from being admitted for pain control and/or realizing they had recurrent cancer and perhaps not fully understanding their state of disease, need additional counseling, from someone other than my nurse practitioner or I, as their primary caregivers, might have trouble conveying the seriousness of where they were […] At that time we tried to breach hospice, she was not accepting. So, as per my previous comments we sent her for palliative care support. Really clarifying what chemotherapy can and can’t do, that’s a discussion I would have with her too, but sometimes when that’s kind of had by multiple different people I think then it’s a little bit easier for someone to shift and say this is no longer achieving what we want to accomplish and it can be a little bit of an easier of a transition, or sometimes patients feel a little bit more at peace with that decision. You know it’s always a better thing when it’s kind of the decision to stop chemo is initiated both by the provider and the patient rather than just the provider saying I’m sorry you can’t have any more chemo, no one wants choices taken away from them.