Organizational factors influencing specialty palliative care utilization at academic cancer centers.

109 Background: Rates of early specialty palliative care utilization remain low, despite increasing familiarity and favorable attitudes amongst cancer center oncologists. In this context, understanding organizational barriers to specialty palliative care use becomes critical.

METHODS: We conducted a qualitative interview study with 74 medical oncologists practicing at 3 U.S. academic cancer centers with well-established specialty palliative care clinics. The in-depth interview guide elicited experiences and views related to outpatient palliative care. For this analysis, we focused on organizational factors influencing palliative care use, defined as the structural arrangements and social patterns that facilitate or impede implementation of best practices in healthcare. The team conducted mixed deductive and inductive coding, using Cabana's quality improvement framework as a starting point. Key concepts were iteratively refined with interdisciplinary input. Two coders applied the final codebook to all transcripts, with disagreements reviewed and resolved by team consensus.

RESULTS: Participating oncologists were 68% male, specialized in solid tumors (61%), hematologic malignancies (32%), or both (7%), and had been practicing oncology for a mean of 17 (SD 12) years. Organizational factors impeding early specialty palliative care utilization included: the perceived burden on patients from spending more time at clinic appointments, which was balanced against the value added from specialty palliative care; social, financial, and disease-related factors interfering with patients' ability to attend additional specialty visits; the clinic name, with concern that patients equated 'palliative care' with death, dying or giving up; an unwieldy referral process without availability of same-day appointments; and inadequate communication between oncologists and palliative care specialists.

CONCLUSIONS: Even when oncologists are aware of the evidence and agree with recommended practices, organizational factors may impede adherence to oncologic and palliative care guidelines. Addressing these barriers could improve use of outpatient specialty palliative care.