Supplement 1
Interview Guide
Thank you so much for agreeing to participate in this interview. I’d like to ask you a few questions about your experiences with outpatient palliative care services. For these questions you can think about your experiences at your current institution, or any previous institution where you worked.
This guide represents themes to be discussed with participants. Specific prompts are listed, however additional prompts may be used as well as non-leading questions such as “Can you tell me a little bit more about that?” and “What does that mean for you?”.
1. Have you ever referred a patient to the outpatient palliative care clinic?
(If yes):
I would like you to think about a specific patient in your clinic that you referred to the outpatient palliative care clinic, and tell me a little bit about them.
Probes:
- Can you tell me what sort of things you considered when you decided to refer this patient to palliative care?
- How did this patient respond to the referral?
- How did the patient’s family respond to the referral?
- How was the experience with the palliative care clinic for you ?
- Can you tell me about how the experience with the palliative care clinic was for the patient?
- Can you tell me about some other situations in which you might refer a patient to the supportive and palliative care clinic?
- What worries or concerns do you have about outpatient palliative care services?
(If no, or to follow question 1…)
2. I would like you to think about a (another) patient in your clinic with advanced cancer that you have not referred to the outpatient palliative care clinic. If possible, please think about a patient who has active symptoms and limited treatment options.
- Can you tell me a little bit about this patient?
- Can you tell me about what you considered when deciding not to refer this patient to palliative care?
Probes:
- Can you tell me more about what you thought about when making the decision about referral to palliative care?
- What factors played into your decision?
- How was making the decision to refer this patient for you?
- Can you tell me about what you see as your role in providing palliative care for your patients?
Now I’d like to ask you a couple of questions about a hypothetical patient in your clinic.
3. Mrs. Smith is a 45 year old with IIIC ovarian cancer who completed therapy three years ago. She presents to your office after imaging has shown a
recurrence. She is having abdominal pain and nausea that have not responded to low dose narcotics and anti-emetics.
- Tell me about your thoughts on Mrs. Smith’s palliative care needs at this point
- Is this a patient you would consider referring to the outpatient palliative care clinic? Why or why not?
Probes
- What would make you more likely to refer Mrs. Smith to the outpatient palliative care clinic?
- What would make you less likely to refer Mrs. Smith to the outpatient palliative care clinic?
- What benefits, if any, would you expect by referring Mrs. Smith to the outpatient palliative care clinic?
- What concerns, if any, would you have in referring Mrs. Smith to the outpatient
palliative care clinic?
Now I’d like to ask you a couple of questions about a different hypothetical patient.
4. Mrs. Jones is a 65 year old with platinum refractory ovarian cancer who presents to discuss treatment options. She is having some mild abdominal discomfort and bloating.
- Tell me about your thoughts on Mrs. Jones’ palliative care needs at this point
- Is this a patient you would consider referring to the outpatient palliative care clinic? Why or why not?
Probes
- What would make you more likely to refer Mrs. Smith to the outpatient palliative care clinic?
- What would make you less likely to refer Mrs. Smith to the outpatient palliative care clinic?
- What benefits, if any, would you expect by referring Mrs. Smith to the outpatient palliative care clinic?
- What concerns, if any, would you have in referring Mrs. Smith to the outpatient
palliative care clinic?
- Are there ways you think about Mrs. Jones differently from Mrs. Smith?
5) Is there anything unique or special about practicing gynecologic oncology that impacts your use of palliative care services?
- Tell me more about this.
6) Is there anything unique or special about the training you received in gynecologic oncology that impacts your use of palliative care services?
- Tell me more about this.
7) How do you think your use of palliative care services compares to your colleagues?
- Tell me more about this.
8) What has been most surprising to you about palliative care?
- Tell me more about this.
9) Tell me about your ideal scenario for how outpatient palliative care is provided for your patients.
10) Is there anything else you think we should know about your experiences with the use of palliative care in gynecologic oncology?
