Personalized cancer genetics training for personalized medicine: improving community-based healthcare through a genetically literate workforce.

PURPOSE: To assess the impact of a multimodal interdisciplinary course on genetic cancer risk assessment and research collaboration for community-based clinicians. Clinicians are increasingly requested to conduct genetic cancer risk assessment, but many are inadequately prepared to provide these services. METHODS: A prospective analysis of 131 participants (48 physicians, 41 advanced-practice nurses, and 42 genetic counselors) from community settings across the United States. The course was delivered in three phases: distance didactic learning, face-to-face training, and 12 months of web-based professional development activities to support integration of skills into practice. Cancer genetics knowledge, skills, professional self-efficacy, and practice changes were measured at baseline, immediate, and 14 months postcourse. RESULTS: Knowledge, skills, and self-efficacy scores were significantly different between practice disciplines; however, postscores increased significantly overall and for each discipline (P < 0.001). Fourteen-month practice outcomes reflect significant increases in provision of genetic cancer risk assessment services (P = 0.018), dissemination of cancer prevention information (P = 0.005) and high-risk screening recommendations (P = 0.004) to patients, patient enrollment in research (P = 0.013), and educational outreach about genetic cancer risk assessment (P = 0.003). CONCLUSIONS: Results support the efficacy of the multimodal course as a tool to develop a genetically literate workforce. Sustained alumni participation in web-based professional development activities has evolved into a distance-mediated community of practice in clinical cancer genetics, modeling the lifelong learning goals envisioned by leading continuing medical education stakeholders.

Impact of fever on outcome in patients with stroke and neurologic injury: a comprehensive meta-analysis.

BACKGROUND AND PURPOSE: Many studies associate fever with poor outcome in patients with neurological injury, but this relationship is blurred by divergence in populations and outcome measures. We sought to incorporate all recent scholarship addressing fever in brain-injured patients into a comprehensive meta-analysis to evaluate disparate clinical findings. METHODS: We conducted a Medline search for articles since January 1, 1995 (in English with abstracts, in humans) and hand searches of references in bibliographies and review articles. Search terms covered stroke, neurological injury, thermoregulation, fever, and cooling. A total of 1139 citations were identified; we retained 39 studies with 67 tested hypotheses contrasting outcomes of fever/higher body temperature and normothermia/lower body temperature in patients with neurological injury covering 14431 subjects. A separate meta-analysis was performed for each of 7 outcome measures. Significance was evaluated with Zc developed from probability values or t values. Correlational effect size, r (es), was calculated for each study and used to derive Cohen's d unbiased combined effect size and relative risk. RESULTS: Fever or higher body temperature was significantly associated with worse outcome in every measure studied. Relative risk of worse outcome with fever was: mortality, 1.5; Glasgow Outcome Scale, 1.3; Barthel Index, 1.9; modified Rankin Scale, 2.2; Canadian Stroke Scale, 1.4; intensive care length of stay, 2.8; and hospital length of stay, 3.2. CONCLUSIONS: In the pooled analyses covering 14431 patients with stroke and other brain injuries, fever is consistently associated with worse outcomes across multiple outcome measures.

Influence of genetic discrimination perceptions and knowledge on cancer genetics referral practice among clinicians.

PURPOSE: To describe nongenetics clinicians' perceptions and knowledge of cancer genetics and laws prohibiting genetic discrimination, attitudes toward the use of cancer genetic testing, and referral practices. METHODS: Invitations to participate were sent to a random stratified sample of California Medical Association members and to all members of California Association of Nurse Practitioners and California Latino Medical Association. Responders in active practice were eligible and completed a 47-item survey. RESULTS: There were 1181 qualified participants (62% physicians). Although 96% viewed genetic testing as beneficial for their patients, 75% believed fear of genetic discrimination would cause patients to decline testing. More than 60% were not aware of federal or California laws prohibiting health insurance discrimination--concern about genetic discrimination was selected as a reason for nonreferral by 11%. A positive attitude toward genetic testing was the strongest predictor of referral (odds ratio: 3.55 [95% confidence interval: 2.24-5.63], P < 0.001) in stepwise logistic regression analyses. The higher the belief in genetic discrimination, the less likely a participant was to refer (odds ratio: 0.72 [95% confidence interval: 0.518-0.991], P < 0.05), whereas more knowledge of genetic discrimination law was associated with comfort recommending (odds ratio: 1.18 [95% confidence interval: 1.11-1.25], P < 0.001) and actual referral (odds ratio: 3.55 [95% confidence interval: 2.24-5.63], P < 0.001). CONCLUSION: Concerns about genetic discrimination and knowledge deficits may be barriers to cancer genetics referrals. Clinician education may help promote access to cancer screening and prevention.

Health beliefs of women with and without breast cancer seeking genetic cancer risk assessment.

Genetic cancer risk assessment (GCRA) is increasingly being incorporated into clinical care. Planning supportive nursing care for women seeking GCRA requires knowledge of their health beliefs. We described and compared the cancer risk-related beliefs of 134 women with a personal history of breast cancer (affected group) and 80 women without breast cancer who had a family history of the disease (unaffected group), prior to risk assessment, using a mailed survey. This article reports their demographics, health characteristics, family history, and beliefs about cancer risk, risk factors, and genetic testing. Most participants were in their 40s (mean age = 47.9), Caucasian (79%), married (66%), and college-educated (60%), and had children (78%). Most women (87%) had a close relative with breast cancer and/or ovarian cancer. In general, both groups greatly overestimated near-term and lifetime cancer risk. Significantly more unaffected women believed they were at higher risk for breast cancer than affected women. Both groups expressed desire for, but lacked knowledge of, genetic testing. Nurses are in a prime position to assist women seeking GCRA by providing accurate information and emotional support regarding cancer risk, risk factors, and genetic testing.

Next-Generation Testing for Cancer Risk: Perceptions, Experiences, and Needs Among Early Adopters in Community Healthcare Settings.

BACKGROUND: Advances in next-generation sequencing (NGS) technologies are driving a shift from single-gene to multigene panel testing for clinical genetic cancer risk assessment (GCRA). This study explored perceptions, experiences, and challenges with NGS testing for GCRA among U.S. community-based clinicians. METHODS: Surveys delivered at initial and 8-month time points, and 12-month tracking of cases presented in a multidisciplinary web-based case conference series, were conducted with GCRA providers who participated in a 235-member nationwide community of practice. RESULTS: The proportion of respondents ordering panel tests rose from 29% at initial survey (27/94) to 44% (46/107) within 8 months. Respondents reported significantly less confidence about interpreting and counseling about NGS compared with single-gene test results (p < 0.0001 for all comparisons). The most cited reasons for not ordering NGS tests included concerns about clinical utility, interpreting and communicating results, and lack of knowledge/skills. Multigene panels were used in 204/668 cases presented during 2013, yielding 37 (18%) deleterious (7% in low/moderate-penetrance genes), 88 (43%) with ≥1 variant of uncertain significance, 77 (38%) uninformative negative, and 2 (1%) inconclusive results. CONCLUSIONS: Despite concerns about utility and ability to interpret/counsel about NGS results, a rapidly increasing uptake of NGS testing among community clinicians was documented. Challenges identified in case discussions point to the need for ongoing education, practice-based support, and opportunities to partner in research that contributes to characterization of lesser known genes.

Decision making in palliative surgery.

BACKGROUND: Palliative surgery for advanced cancer patients involves complex decision making. Surgeons with a cancer-focused practice were surveyed to determine the extent to which palliative surgery was currently practiced, to identify ethical dilemmas and barriers they faced in performing palliative surgery, and to evaluate their treatment choices in four different clinical scenarios. STUDY DESIGN: A 110-item survey was devised after extensive review of the palliative care and palliative surgery literature to evaluate current practices and attitudes regarding palliative surgery. Case vignettes were devised to evaluate dinical factors influencing surgeons' selection of treatment for symptomatic patients with advanced malignancy. RESULTS: Survey response rate was 24% (419 of 1,740). Respondents reported 74% of their surgery caseload as cancer related, and 21% of these as palliative. On a scale of 1 (uncommon problem) to 7 (common problem), surgeons reported that the most common ethical dilemmas in palliative surgery were providing patients with honest information without destroying hope (5.6 +/- 1.4) (mean +/- standard deviation), and preserving patient choice (5.0 +/- 1.7). Bound on error of the average frequency estimate for ethical dilemmas, based on response rate, was 0.08. On a scale of 1 (not a barrier) to 7 (a severe barrier), surgeons rated the most severe barriers to optimum use of palliative surgery as limitations of managed care (4.1 +/- 2.0) and referral to surgery by other specialists (3.9 +/- 1.8). Bound on error of the estimate for average severity of barriers, based on response rate, was 0.09. They rated the least severe barriers to palliative surgery as surgeon avoidance of dying patients (3.0 +/- 1.8) and surgery department reluctance to perform palliative surgery (2.6 +/- 1.6). Analysis of surgeons' treatment selection in case vignettes indicated that patient age, aggressiveness of tumor biology, local extent of disease, and severity of patient symptoms were all variables of influence for treatment selection in patients with advanced malignancies. CONCLUSIONS: Palliative surgery involves numerous ethical dilemmas, the most prominent being providing honest information to patients without destroying hope, and complex treatment decision making. We have identified variables of major influence to surgeons in the palliative treatment selection for patients with advanced, solid malignancies. Validation of these variables as meaningful will require future studies focusing on patient outcomes.

A qualitative analysis of cancer-related fatigue in ambulatory oncology.

The purpose of this study was to describe patients' perceptions of the causes, relief, related symptoms, meaning, and suffering secondary to cancer-related fatigue (CRF). In total, 252 patients with breast, lung, colon, and prostate cancers were enrolled in a quasiexperimental study to test the effects of a clinical intervention on reducing barriers to symptom management in ambulatory care. Analysis of data reported in this article was derived from the Piper Fatigue Scale-Revised. Using qualitative research methods and content analysis, written statements related to the impact of CRF were coded using the following themes: patients' perceptions of CRF, causes, relief, related symptoms, meaning, and suffering. Comments were categorized and reviewed for content. Overall, CRF had a significant impact on physical, psychological, social, and spiritual well-being. CRF limited the ability of participants to function, socialize, and participate in enjoyable activities. Emotional issues as a result of CRF were common. The negative impact of CRF on patients' overall well-being alters the meaning and suffering related to the cancer experience. The assessment of personal meaning and suffering related to CRF is an important component of the multidimensional assessment of CRF and will enable nurses to better understand the suffering related to CRF.

Mindful movement program for older breast cancer survivors: a pilot study.

BACKGROUND: Older breast cancer survivors (BCSs) are at risk for late and long-term treatment effects on quality of life (QOL), including lower physical functioning and fear of recurrence. Two promising approaches to address this include dance/movement therapy and mindfulness. OBJECTIVE: The purpose of this 2-group randomized controlled pilot feasibility study was to test short-term effects of a 12-week Mindful Movement Program (MMP) intervention combining mindfulness with self-directed movement on QOL and mindfulness in female BCSs 50 years or older and at 12 months or more following treatment. METHODS: Consented participants were randomized to an experimental group (EG) (12 weekly MMP sessions) or a control group (no sessions). All completed questionnaires 3 times. The EG participants kept home practice diaries. Analysis was conducted after intervention for immediate effects on outcome variables and 6 weeks later for maintenance of effects. RESULTS: Participants (n = 49) ranged in age from 50 to 90 years (average, 65.6 years) and were at 9.8 years since diagnosis (range, 1-32 years), and the majority were white, unpartnered, and retired. After intervention, EG participants showed improved QOL via decreased fear of recurrence and increased mindfulness attitude. At 6 weeks, initial effects were retained. CONCLUSIONS: The MMP appears to benefit older BCSs by reducing fear of recurrence and improving mindfulness attitude. Although these findings are promising, a larger study is needed to determine more specifically what short- and long-term effects are possible. IMPLICATIONS FOR PRACTICE: The combination of self-directed movement and mindfulness, as tested here, may be a valuable tool for promoting health and well-being in older long-term survivors of breast cancer.

Introducing a new incontinence management system for nursing home residents.

OBJECTIVES: To describe current practices of incontinence care in nursing homes (NHs) provided by certified nurse assistants (CNAs), and to evaluate the feasibility and acceptability of an integrated incontinence care product, the One Step Incontinence System (OSIS) in the NH setting. While the ultimate purpose of OSIS is to encourage more consistent skin cleansing and thus reduce perineal dermatitis and risk of pressure ulcers, this study reports an initial feasibility test of OSIS. DESIGN: Controlled trial at two NH sites, with one ward at each site assigned to intervention with OSIS and one ward at each site assigned to a control condition with a box of wipes placed at the bedside (BW). SETTING: Two NHs (one community and one Veterans Administration) in the Los Angeles area. PARTICIPANTS: 24 incontinent NH residents and 61 CNAs. INTERVENTION: OSIS integrates an adult brief and two cleansing/protective wipes into a single item by way of a waterproof pouch that is removed at the time of incontinence care. The OSIS briefs were placed on the intervention wards in the same location(s) and adjacent to regular adult briefs. MEASUREMENTS: Structured observations of incontinence care episodes were performed by trained research staff at baseline on all wards, and at follow-up with either the intervention (OSIS) or control condition (BW) in place. Observations included resident location, thoroughness and duration of incontinence care, and materials used. In addition, CNAs' opinions of their preferred incontinence care materials and their experience using OSIS were obtained by self-administered survey. RESULTS: Use of OSIS resulted in significantly greater frequency of use of cleansing wipes (97% of episodes) compared to the baseline (77% of episodes) and BW conditions (41% of episodes). In 59% of the observed episodes in the BW condition, the box of wipes was actually missing from the bedside, or completely absent from the patient's room and had to be replaced. The two wipes that were incorporated with OSIS were used for perineal skin cleansing immediately when providing incontinence care. There was a significant reduction in the percentage use of and number of cloth towels used during incontinence care with OSIS (53% of episodes, 0.8 towels) compared to baseline (67%, 1.1 towels) and BW conditions (82%, 1.2 towels; p=.002 and p=.012, respectively). CNAs were significantly less often interrupted by the need to find supplies during OSIS condition (13%) compared to baseline (23%) and BW (36%; p= .005). There were no significant differences between conditions in the thoroughness of observed cleansing. The average observed time for incontinence care from putting on gloves to fastening the clean adult brief (T1) and between uncovering the resident to fastening a clean adult brief (T2) decreased significantly within both groups (OSIS and BW) at follow-up (all p-values <.05), but there were no significant differences in T1 and T2 between groups at follow-up. CNAs were more likely to report that they felt that OSIS facilitated skin cleansing compared to the BW. CONCLUSION: We successfully implemented a trial of an innovative adult brief that encouraged skin cleansing during incontinence care. The system was easily and effectively incorporated into the nursing home, was used by CNAs whenever available (97% of the time), and was favored by CNAs. Patterns of incontinence care differed at follow-up with OSIS compared to BW, with fewer linens used, fewer wipes used, and less CNA interruption during care, which may result in greater privacy and comfort for residents.

Implementation and results of the statewide ONHRSS.

In response to increased consumer demand, state governments are publishing more detailed information about the quality of nursing homes. In 2002, Ohio legislation mandated the publication of a Long-Term Care Consumer Guide that included information on nursing home resident and family satisfaction surveys. Using the 2002 Ohio Nursing Home Resident Satisfaction Survey as an example, this article addresses two research questions: (1) how can statewide resident face-to-face satisfaction interviews be implemented to maximize participation of residents and facilities and produce reliable and valid results, and (2) how satisfied are residents with their nursing home experiences, overall and by level of cognitive function.

Beliefs and interest in cancer risk in an underserved Latino cohort.

OBJECTIVE: To measure beliefs about cancer causation, cancer screening behaviors, access to information about and resources for cancer screening, and interest in cancer genetics services in two underserved predominantly Latino communities. METHODS: An anonymous survey, in both English and Spanish, was distributed at the registration desk to all attendees of selected general medicine clinics in two underserved healthcare systems. RESULTS: There were a total of 312 respondents, representing 98% of eligible candidates. The reported data focus on 75.3% (n=235) of Latino respondents; mean age 43 years; 78% female; 72% less than high school education. Heredity was perceived as the most frequent cause of cancer, after smoking. Only 37% knew of free cancer screening programs. Over 85% expressed interest in obtaining information about personal cancer risk and motivation to participate in cancer genetics services. CONCLUSIONS: The results of this survey demonstrate an awareness of heredity as a potential cause of cancer. The observed high level of interest in cancer genetics services suggests the acceptability of cancer genetics services in this predominantly underserved Latino population. Furthermore, cancer genetics services would likely augment awareness and utilization of available cancer screening services in the community.

Cancer screening and risk-reducing behaviors of women seeking genetic cancer risk assessment for breast and ovarian cancers.

PURPOSE/OBJECTIVES: To examine breast and ovarian cancer screening and risk-reducing behaviors of women seeking genetic cancer risk assessment (GCRA). DESIGN: Descriptive, cross-sectional. SETTING: An insurance-based clinic that serves high-risk patients in a southern California cancer center. SAMPLE: 134 women with breast or ovarian cancer (affected group) and 80 women with a family history of breast or ovarian cancer (unaffected group). The mean age of the sample was 48 years (range = 21-86), 79% were Caucasian, 66% were married, 60% were college educated, and 78% had children. Most affected women had early-stage disease. Unaffected women had a family history of breast (86%) or ovarian (14%) cancer. METHODS: Mailed surveys assessed pre-GCRA health behaviors and health and family histories. MAIN RESEARCH VARIABLES: Breast cancer screening (mammograms, clinical breast examination [CBE], breast self-examination), ovarian cancer screening (CA-125, pelvic ultrasound), and breast and ovarian cancer risk-reducing strategies (tamoxifen, bilateral mastectomy, oral contraceptive pills, bilateral salpingo-oophorectomy). FINDINGS: Twenty-one percent of the women who should have been having a mammogram had not had an annual examination as recommended, and 30% of affected women had not had annual CBEs. Few women took tamoxifen or oral contraceptive pills or had a bilateral salpingo-oophorectomy or bilateral mastectomy for cancer risk reduction. Twelve percent likely had unnecessary ovarian cancer screening. About 35% used other means, including herbs and homeopathy, for cancer prevention. CONCLUSIONS: Nearly a third of the affected women had not had appropriate breast cancer screening. About 12% used unsubstantiated, potentially harmful cancer "prevention" measures (e.g., herbs). IMPLICATIONS FOR NURSING: Nurses should assess clients' personal and family breast and ovarian cancer histories and promote cancer screening and risk-reducing behaviors that are appropriate for age and risk level.

Perspectives on the impact of ovarian cancer: women's views of quality of life.

PURPOSE/OBJECTIVES: To describe quality-of-life (QOL) concerns particular to women with ovarian cancer and to examine whether subgroups of patients with ovarian cancer have significantly different QOL concerns. DESIGN: Mailed survey. SAMPLE: Readership of an ovarian cancer newsletter. METHODS: A total of 1,383 surveys were received in response to the survey's inclusion in the November 2002 issue of Conversations! The International Newsletter for Those Fighting Ovarian Cancer, a monthly newsletter circulated to 3,300 women with ovarian cancer (response rate = 42%). Women were asked to complete the 45-item City of Hope QOL Ovarian Cancer Tool (QOL-OVCA) and a short demographic questionnaire. MAIN RESEARCH VARIABLES: Patients' QOL-OVCA scores were compared across six independent variables, including disease status, age at diagnosis, stage at diagnosis, marital status, household income, and use of alternative therapy, controlling for survival time. FINDINGS: Ovarian cancer survivors reported significant QOL concerns across dimensions of physical, psychological, social, and spiritual well-being. CONCLUSIONS: Patients with ovarian cancer experience particular QOL concerns requiring support. Future research is needed to describe the needs of survivors in more diverse populations and to develop and test interventions that can address these QOL concerns. IMPLICATIONS FOR NURSING: Women with ovarian cancer experience QOL concerns common to other patients with cancer and some that are particular to ovarian cancer. Nurses should assess for and aggressively address these QOL concerns.

On the meaning of "drug seeking".

The term "drug seeking" is frequently used but poorly defined. By soliciting nurses' comments and suggestions, a survey was developed to identify behaviors that may cause nurses to refer to a patient as drug seeking, to identify what nurses think the term "drug seeking" means, to explore how nurses regard the use of the term "drug seeking" in health care, and to identify differences between general nurses, emergency nurses, and pain management nurses with regard to these items. Behaviors that would cause the majority of all three nurse groups to refer to a patient as drug seeking were as follows: going to different emergency departments to get opioids, telling inconsistent stories about pain or medical history, or asking for a refill because the prescription was lost or stolen. When the term "drug seeking" is used, all three groups of nurses agreed that it was very likely to mean the patient was addicted to opioids, the patient was abusing pain medicine, or the patient was manipulative. One-half or more for each nurse group said they used the term "drug seeking" in talking about patients, but less than 10% said they used it in charting. After completing the survey, approximately one half or more of nurses in each group were less inclined to use the term. The use of stigmatizing terms in clinical practice is addressed with suggestions for alternative approaches to patient behavior related to requesting opioids for pain relief.

Outcomes from intensive training in genetic cancer risk counseling for clinicians.

PURPOSE: Genetic cancer risk assessment is an emerging interdisciplinary practice that requires knowledge of genetics and oncology and specialized patient and family counseling skills. There is a growing need for cancer risk assessment practitioners, but most clinicians have inadequate cross-disciplinary training. An interdisciplinary course was developed to promote practitioner-level competency in cancer risk assessment to community-based clinicians. METHODS Participants were competitively selected from a pool of board-certified/eligible genetic counseling, masters-trained advanced practice nursing and physician applicants. Preference was given to clinicians with strong institutional backing practicing in underserved regions. The Continuing Medical Education/Continuing Education Unit-accredited course included didactic lectures, workshops, counseling practicum, and case conferences. Pre- and postcourse knowledge tests measured cancer genetics knowledge. Six month and one-year postcourse practice outcome surveys measured the impact of the program on professional self-efficacy and continued professional development. RESULTS/CONCLUSIONS: Forty clinicians completed the course (23 genetic counselors, 14 nurses, and three physicians). There was a significant overall increase of 22.6% in postcourse knowledge scores (P < 0.001). Thirty-five (88%) completed prescribed practice development activities. Of 29 respondents to 1-year postcourse survey, 76% reported increased professional self-efficacy; 66% reported increase in number of patients seen, and virtually all indicated interest in additional training. Outcomes demonstrate the value and efficacy of interdisciplinary training in genetic cancer risk assessment targeted to motivated community-based clinicians. Courses such as this can help address the need for competent cancer risk assessment services in communities outside the academic health center.

Elevated body temperature independently contributes to increased length of stay in neurologic intensive care unit patients.

OBJECTIVE: Elevated temperature results in worse outcome in experimental models of cerebral ischemia and brain trauma. In critically ill neurologic and neurosurgical patients, elevated body temperature is common and is associated with neurologic deterioration and poor outcome. We sought to determine whether, after controlling for age, severity of illness, and complications, elevated body temperature remained an important predictor of intensive care unit (ICU) and hospital length of stay, mortality rate, and hospital disposition in a large cohort of patients emergently admitted to a neurologic ICU. DESIGN: Prospectively collected data (demographics, diagnosis, Acute Physiology and Chronic Health Evaluation II score, Glasgow Coma Scale score, daily maximum temperature, complications, disposition) were retrospectively reviewed. SETTING: A 20-bed neurology/neurosurgery ICU in a tertiary care academic, level I trauma, referral center. SUBJECTS: From 6,759 admissions, those admitted after an elective procedure with length of stay < or = 1 day, those <18 yrs old, and those with incomplete data were excluded, leaving 4,295 patients for this analysis. First, a hierarchical multiple regression analysis was performed to determine whether elevated body temperature was an independent predictor of length of stay. Second, a path analysis was performed to define the relationships among elevated body temperature, complications, and length of stay. Finally, a matched, weighted sample was developed to quantify the difference in length of stay. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We measured ICU and hospital length of stay, mortality rate, and discharge disposition. The presence of elevated body temperature was associated with a dose-dependent longer ICU and hospital length of stay, higher mortality rate, and worse hospital disposition. The most important predictor of ICU length of stay was the number of complications (beta =.681) followed by elevated body temperature (beta =.143). In the matched, weighted population, the presence of elevated body temperature was associated with 3.2 additional ICU days and 4.3 additional hospital days. CONCLUSION: In a large cohort of neurologic ICU patients, after we controlled for severity of illness, diagnosis, age, and complications, elevated body temperature was independently associated with a longer ICU and hospital length of stay, higher mortality rate, and worse outcome.

Indications and use of palliative surgery-results of Society of Surgical Oncology survey.

BACKGROUND: Despite increasing attention to end-of-life care in oncology, palliative surgery (PS) remains poorly defined. A survey to test the definition, assess the extent of use, and evaluate attitudes and goals of surgeons regarding PS was devised. METHODS: A survey of Society of Surgical Oncology (SSO) members. RESULTS: 419 SSO members completed a 110-item survey. Surgeons estimated 21% of their cancer surgeries as palliative in nature. Forty-three percent of respondents felt PS was best defined based on pre-operative intent, 27% based on post-operative factors, and 30% on patient prognosis. Only 43% considered estimated patient survival time an important factor in defining PS, and 22% considered 5-year survival rate important. The vast majority (95%) considered tumor still evident following surgery in a patient with poor prognosis constituted PS. Most surgeons felt PS could be procedures due to generalized illness related to cancer (80%) or related to cancer treatment complications (76%). Patient symptom relief and pain relief were identified as the two most important goals in PS, with increased survival the least important. CONCLUSION: PS is a major portion of surgical oncology practice. Quality-of-life parameters, not patient survival, were identified as the most important goals of PS.