What are the barriers for medical oncologists to initiate a palliative care discussion to their incurable patients? A qualitative interview study in Flanders, Belgium.

Objectives: Before referring their patients to a palliative care service, oncologists need to inform and discuss with them issues of disease stage, prognosis and the possible advantaged of specialized palliative care (SPC). This is a very complex and emotional task for the oncologist with which they often struggle. As a result, oncologists refer their patients to SPC too late in their disease course or even not at all. This study reports findings from interviews with Belgian medical oncologists identifying oncologists’ barriers for introducing palliative care in discussions with their patients with advanced cancer.
Methods: An explorative, qualitative interview study with 15 medical oncologists from academic as well as non-academic Medical Oncology Departments in Flanders, Belgium. The transcripts of the interviews were analysed during an iterative process using the grounded theory principles of open and axial coding until a final coding framework was reached.
Results: The study identified seven heterogeneous categories of barriers discouraging oncologists from discussing palliative care with their advanced cancer patients: oncologist-related barriers ( e.g. emotional commitment, lack of experience and emotional discomfort); patient-related barriers (e.g. specific patient characteristics and emotional reactions); family-related barriers with regard to the family member attending the discussion; barriers related to the physician referring the patient to the medical oncologist; barriers related to disease or treatment; institutional/organisational barriers ( as for example the availability of palliative care and the practical organisation within a hospital); social/policy barriers, e.g. palliative care stigma.
Discussion/implications: The medical oncologists reported a variety of barriers, many of which may be manageable, e.g. through a specific communication training. The exploration and description of these barriers may serve as a starting point for training programs to encourage and support oncologists in introducing and discussing palliative care openly and timely in the disease trajectory of a cancer patient.