Supportive Care in Cancer

, Volume 16, Issue 3, pp 217–222

Barriers to referral to inpatient palliative care units in Japan: a qualitative survey with content analysis

  • Mitsunori Miyashita
  • Kei Hirai
  • Tatsuya Morita
  • Makiko Sanjo
  • Yosuke Uchitomi
Supportive Care International

DOI: 10.1007/s00520-007-0215-1

Cite this article as:
Miyashita, M., Hirai, K., Morita, T. et al. Support Care Cancer (2008) 16: 217. doi:10.1007/s00520-007-0215-1



We investigated the barriers to referral to inpatient palliative care units (PCUs) through a qualitative study across various sources of information, including terminal cancer patients, their families, physicians, and nurses.

Materials and methods

There were 63 participants, including 13 advanced cancer patients, 10 family members, 20 physicians, and 20 nurses in palliative care and acute care cancer settings from five regional cancer institutes in Japan. Semi-structured interviews were conducted regarding barriers to referral to PCU, and data were analyzed by content analysis method.


A total of 21 barriers were identified by content analysis. The leading barriers were (1) a negative image of PCUs by patients and families (n = 39), (2) delay of termination of anti-cancer treatment by physicians in the general wards (n = 24), (3) unwillingness to end anti-cancer treatment and denial of the fatal nature of the disease by patients and families (n = 22), (4) patient’s wish to receive care from familiar physicians and nurses (n = 20), and (5) insufficient knowledge of PCUs by medical staff in general wards (n = 17).


To correct these unfavorable images and misconceptions of PCUs, it is important to eliminate the negative image of PCUs from the general population, patients, families, and medical staffs. In addition, early introduction of palliative care options to patients and communication skills training regarding breaking bad news are relevant issues for a smooth transition from anti-cancer treatment to palliative care.


Palliative care Hospice Neoplasms Referral and consultation Qualitative research 

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Mitsunori Miyashita
    • 1
  • Kei Hirai
    • 2
  • Tatsuya Morita
    • 3
  • Makiko Sanjo
    • 1
  • Yosuke Uchitomi
    • 4
  1. 1.Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of MedicineThe University of TokyoTokyoJapan
  2. 2.Graduate School of Human SciencesOsaka UniversityOsakaJapan
  3. 3.Department of Palliative and Supportive Care, Palliative Care Team and Seirei HospiceSeirei Mikatahara HospitalShizuokaJapan
  4. 4.Psycho-Oncology Division, Research Center for Innovative OncologyNational Cancer Center Hospital EastChibaJapan

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