Oncologists' and Physiatrists' Attitudes Regarding Rehabilitation for Patients With Advanced Cancer

Objective: To determine whether differences in attitude and practice between physiatrists and oncologists exist that may be barriers to patients with advanced cancer receiving rehabilitation services. Design: A survey of medical oncologists' and rehabilitation physicians' self-reported referral attitudes and behaviors regarding rehabilitation services for patients with advanced cancer defined as the prognosis expected to lead to death in 6-12 months. After a prenotification letter, surveys were mailed to a systematically drawn sample. A final survey population of 591 medical oncologists and 464 rehabilitation physicians was created from prenotification and survey mailings. Participants: Practicing physiatrists and oncologists listed in the American Academy of Physical Medicine and Rehabilitation and American Society of Clinical Oncology membership directories. Main Outcome Measurements: Responses to survey questions by physiatrists and oncologists. Results: From 820 surveys mailed, 395 surveys were returned, for a total response rate of 46%. When asked about how a terminal prognosis of patients with advanced cancer affects rehabilitation referral and acceptance, only 8% of medical oncologists said that they would refer a patient with advanced cancer to rehabilitation services regardless of estimated prognosis, whereas 35% of rehabilitation physicians said that they would accept a patient with advanced cancer for rehabilitation services regardless of prognosis. Approximately 70% of both medical oncologists and rehabilitation physicians thought it to be very important that patients with advanced cancer who are referred and accepted into rehabilitation services adequately understand their prognosis before beginning a rehabilitation program. However, only 39% of rehabilitation physicians, compared with 61% of medical oncologists, believed that patients with advanced cancer and in rehabilitation services adequately understood their prognosis (P = .004). As surveyed, a do not resuscitate order had no effect on a medical oncologist's willingness to refer a patient with advanced cancer to rehabilitation services and had minimal effect on a rehabilitation physician's willingness to accept a patient with advanced cancer. Conclusion: Medical oncologists and rehabilitation physicians share many similar attitudes with regard to the referral and acceptance of patients with advanced cancer for rehabilitation services. However, medical oncologists see prognosis as a more significant barrier to rehabilitation services than do rehabilitation physicians. Rehabilitation physicians are more likely to believe that the patients with advanced cancer for whom they care do not adequately understand their prognosis.