Abstract
Despite the known benefits, healthcare systems struggle to provide early, integrated palliative care (PC) for advanced cancer patients. Understanding the barriers to providing PC from the perspective of oncology clinicians is an important first step in improving care. A 33-item online survey was emailed to all oncology clinicians working with all cancer types in Alberta, Canada, from November 2017 to January 2018. Questions were informed by Michie’s Theoretical Domains Framework and Behaviour Change Wheel (BCW) and queried (a) PC provision in oncology clinics, (b) specialist PC consultation referrals, and (c) working with PC consultants and home care. Respondents (n = 263) were nurses (41%), physicians (25%), and allied healthcare professionals (18%). Barriers most frequently identified were “clinicians’ limited time/competing priorities” (64%), “patients’ negative perceptions of PC” (63%), and clinicians’ capability to manage patients’ social issues (63%). These factors mapped to all three BCW domains: motivation, opportunity, and capability. In contrast, the least frequently identified barriers were clinician motivation and perceived PC benefits. Oncology clinicians’ perceptions of barriers to early PC were comparable across tumour types and specialties but varied by professional role. The main challenges to early integrated PC include all three BCW domains. Notably, motivation is not a barrier for oncology clinicians; however, opportunity and capability barriers were identified. Multifaceted interventions using these findings have been developed, such as tip sheets to enhance capability, reframing PC with patients, and earlier specialist PC nursing access, to enhance clinicians’ use of and patients’ benefits from an early PC approach.
Highlights
Patient symptom and quality of life outcomes are known to improve when palliative care (PC) is provided concurrently with cancer-modifying therapies [1,2]
Providing early and integrated PC with cancer care is challenging for many reasons, including patients’ and families’ negative perceptions of PC [10], providers’ perceptions of PC [11,12], and the healthcare system’s siloed and fragmented organizational structure [13,14] The known factors impacting whether providers consider PC for patients include knowledge of available PC services, clarity and simplicity of referral processes, clinician time and competing priorities, communication issues, and role confusion within and between care teams [15,16]
This study examined behavioural influences impacting when and how oncology clinicians refer advanced cancer patients to PC services
Summary
Patient symptom and quality of life outcomes are known to improve when palliative care (PC) is provided concurrently with cancer-modifying therapies [1,2]. Abrupt transitions from cancer-modifying treatments to palliative-focused care can cause unnecessary distress and suffering. For these reasons, clinical practice guidelines [3,4,5,6] increasingly recognize the integration of cancer care with PC as “best practice” for many patients with advanced cancer. Providing early and integrated PC with cancer care is challenging for many reasons, including patients’ and families’ negative perceptions of PC [10], providers’ perceptions of PC [11,12], and the healthcare system’s siloed and fragmented organizational structure [13,14] The known factors impacting whether providers consider PC for patients include knowledge of available PC services, clarity and simplicity of referral processes, clinician time and competing priorities, communication issues, and role confusion within and between care teams [15,16]
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