Identifying barriers to oncologist referral to palliative care: A dual approach.

121 Background: Longitudinal palliative care has demonstrated benefits for cancer patients, and the American Society for Clinical Oncology recommends that palliative care be used along with standard anti-cancer therapy at the diagnosis of serious disease. However, studies have shown that oncologists still often refer to palliative care within days of the end of life, or not at all. This indicates that oncologists face barriers, systems-based or self-imposed, to palliative care referral. This study aims to identify specific barriers that prevent oncologists from referring cancer patients to palliative care services.

METHODS: Barriers to referral were identified via a dual approach. A literature review was performed using a PubMed search of articles published since 2012, when the ASCO provisional opinion was issued. This was narrowed down to 27 articles that meaningfully commented on barriers that oncologists face in referring to palliative care. Additionally, a qualitative analysis of semi-structured interviews of five practicing oncologists was performed. Oncologists interviewed for the study practice in a cancer center affiliated with an academic tertiary hospital.

RESULTS: 20 distinct barriers to referral, both systems-based and at the individual provider level, were enumerated from the literature review and interview analysis.

CONCLUSIONS: Oncologists face a wide range of specific barriers that prevent appropriate referral to palliative care, related both to the logistics of the healthcare system and to providers' preconceptions about palliative care. A significant barrier at the oncologist level is a tendency to associate palliative care exclusively with the end of life, despite demonstrated benefits earlier in the course of disease.