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

Context Specialised palliative care (SPC) SPC for advanced cancer Positive effect on QoL (quality of life) Positive effect on survival time SPC for advanced cancer Oncologists refer their advanced cancer patients (too) late in their disease course Before referring patients to SPC  open en realistic discussion about disease stage, prognosis, treatment options and advantages of SPC

Research Question What are possible barriers for (Flemish) medical oncologists to initiate SPC (for the first time) to their advanced cancer patients?

Methods Qualitative interview study Explorative, open, face-to-face interviews Grounded Theory approach

Results 82 letters of invitation 15 certified medical oncologists from academic and non-academic hospitals in Flanders 11 male and 4 female 5 from an academic hospital and 10 from a non-academic hospital Age range: 37 to 70 years Work experience: 8 to 44 years Average duration of the interviews: 47.93 minutes

Categories Oncologist related barriers Patient related barriers Family related barriers Barriers related to the referring physician Barriers related to disease or treatment Institutional/organisational barriers Societal/policy barriers

Oncologist related barriers Lack of training and education In communciation skills In palliative care Feeling of failure Fear of depriving hope

Patient related barriers Emotions (sadness/anger) Unrealistic expectations Unrealistic trust and faith in medicine Giving up hope

Family related barriers Protection of the patient Unrealistic expectations/disagreement about goals of care and treatment Emotional reactions

Barriers related to the referring physician Lack of agreement for referral to the medical oncologist Late referral Reluctance to discuss disease stage

Barriers related to disease or treatment Therapeutic options/phase 1 trails Inability to estimate prognosis Unexpected/unpredictable progression

Institutional/organisational barriers Availibility of palliative care Practical organisation Workload Lack of support/coaching for oncologists

Societal and policy barriers Palliative care stigma Negative connotation palliative care Misunderstandig concept palliative care Education and training Lack of integration of palliative care in medical education Lack of CST for medical oncology Predominance of the curative model

Conclusions Oncologists still entertain the ‘old’ concept of palliative care This concept of palliative care is still predominant among patients, families and on societal level Lack of training in communication skills during their medical training Lack of support and coaching for medical oncologists

Conclusions

Contact mhorlait@vub.ac.be End-of-life Care Research Group Vrije Universiteit Brussel & Ghent University Faculty of Medicine Laarbeeklaan 103 B-1090 Brussels (Belgium)

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