Palliative Care Early and Systematic (PaCES): A survey of colorectal cancer clinicians of barriers and facilitators to early palliative care integration.

Abstract

128 Background: Health systems struggle to systematically provide early and integrated palliative care (PC) to cancer patients. In Alberta, Canada, the PaCES (Palliative Care Early and Systematic) project is addressing this need by building an early PC pathway for advanced colorectal cancer (CRC) patients. As part of this work, we aimed to characterize barriers and facilitators to: a) providing primary palliative care to CRC patients; b) referring CRC patients for PC specialist consults; and c) working with specialist PC and home care services. Methods: This observational, knowledge translation questionnaire study collected both quantitative and open-ended responses from physicians, nurses and other allied health care professionals (HCP) working with advanced CRC patients in Alberta, Canada. Survey questions and format were informed by Michie’s Theoretical Domains Framework. The strength of this framework is that, in addition to identifying specific barriers to delivering early PC, it also maps out suggested solutions to addressing these barriers. Results: The survey response rate was 43% (65/150). 89% of the respondents were physicians or nurses with Medical Oncology as the primary discipline. Time and competing priorities were the biggest barriers to HCPs addressing patients PC needs (65%). Next, role confusion when working with PC teams, and lack of clear process for executing new orders when patients are at home, were identified by over 55% of HCPs as a barrier. Other aspects of working with PC teams, including, lack of standardized communication processes and inadequate documentation processes, were barriers as perceived by over 45% of HCPs. Over 90% of HCPs surveyed believe earlier PC is likely to benefit their patients, and would recommend an earlier PC pathway to their patients. Conclusions: In Alberta, the main barriers to early PC integration are no longer attitudinal, with over 90% believing that early PC is beneficial for their patients. Time needed to address PC needs in a busy oncology clinic is a barrier. A pathway to improve clarity around referral processes and role confusion when working with PC teams will be developed to address these barriers.