125 Background: Physicians caring for patients with terminal cancer are at particular risk for compromised well-being due to the nature and intensity of the clinical stresses they face. The factors contributing to professional burnout severity included younger age, working in isolation, and working longer hours a shown by a survey conducted by Kamal et al. For patient encounter distress multiple factor have been mention as a source of distress for providers including patient factors, physician factors and environmental factors. No documented evidence of the distress level in palliative care (PC) providers after patient encounter is available. We intend to identify the most common predictors for high distress level after patient encounter in order to identify ways to support our staff. Methods: A group of 28 PC faculty physicians and mid-level providers in the Department of PC at the M. D. Anderson Cancer Center were invited to participate in the study by email with Qualtrics link e-online questionnaire. The questionnaire seek their opinion on the most important interaction or situations that increase their distress level during a PC consult. A 5-point Likert scale of agreement was used, ranging from “strongly disagree” to “strongly agree”. We will conduct the procedure to generate the question prompt sheet with 3 Delphi rounds. Results: After the first round of the Delphi the situations that could cause distress after a consult with more than 80% agreement were identify as: difficult family, manipulative family/patient, angry patient/family, primary team in denial, time of the consult, and number of consults. Situations like patient's terminal diagnosis, patient/family religious beliefs, cultural background, or presence of observer or trainee were less likely consider as source of distress with a less than 20% agreement. Conclusions: For PC specialists situations that affect the communication or rapport with patients as well as amount/burden of clinical work seems to be more a source of distress. Other situations related to uncontrolled symptoms, EOL issues or patient background were less likely a source of distress what could be explain by the expertise of the specialist with these EOL discussions and symptom management.