Skip to main content

Integrating home palliative care in oncology: a qualitative study to identify barriers and facilitators



Access to and close links with home palliative care services are essential to ensure seamless transitions between care settings in anticancer treatment. However, the timing of referrals to home palliative care services is often delayed. We explored barriers to and facilitators of improving the integration of home palliative care and medical oncology experienced by healthcare professionals in Japan.


This qualitative study involved semi-structured focus groups and individual interviews conducted via a web conferencing system. Participants were 27 healthcare professionals, including oncologists, palliative care physicians, home palliative care physicians, nurses from both cancer hospitals and home visit nursing agencies, and social workers from cancer hospitals.


Barriers and facilitators were grouped into three themes: (1) perspectives and ideas on integrating oncology and home palliative care; (2) barriers; and (3) facilitators. Barriers included seven sub-themes: lack of referral criteria for home palliative care services; financial elements related to home palliative care services; patients’ lack of understanding of the illness trajectory; collusion in doctor-patient communication about imminent death; frequent visits to cancer hospitals; variations in home palliative care services; and problems in providing treatment and care at home. Facilitators included two sub-themes: relationships between oncologists and home palliative care physicians, and cancer hospital staff experience/knowledge of home palliative care.


This study identified barriers and facilitators to integrating home palliative care and oncology. Some barriers experienced by professionals were comparable with barriers to early integration of palliative care into oncology.

This is a preview of subscription content, access via your institution.

Data Availability

To protect participants’ privacy, no original data can be released. Deidentified data from this study are kept by AY and are available upon reasonable request.


  1. Gomes B, Calanzani N, Gysels M et al (2013) Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care 12:7

    Article  Google Scholar 

  2. Cohen J, Houttekier D, Onwuteaka-Philipsen B et al (2010) Which patients with cancer die at home? A study of six European countries using death certificate data. J Clin Oncol 28(13):2267–2273

    Article  Google Scholar 

  3. Gomes B, Calanzani N, Curiale V, et al(2013) Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev (6):Cd007760.

  4. Shepperd S, Gonçalves-Bradley DC, Straus SE et al (2021) Hospital at home: home-based end-of-life care. Cochrane Database Syst Rev 3(3):Cd009231

    PubMed  Google Scholar 

  5. Gaertner J, Siemens W, Meerpohl JJ et al (2017) Effect of specialist palliative care services on quality of life in adults with advanced incurable illness in hospital, hospice, or community settings: systematic review and meta-analysis. BMJ (Clinical research ed). 357:j2925

    Article  Google Scholar 

  6. Pellizzari M, Hui D, Pinato E et al (2017) Impact of intensity and timing of integrated home palliative cancer care on end-of-life hospitalization in Northern Italy. Support Care Cancer 25(4):1201–1207

    CAS  Article  Google Scholar 

  7. Haun MW, Estel S, Rücker G et al (2017) Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev 6(6):Cd011129

    PubMed  Google Scholar 

  8. Fukui S, Fujita J, Tsujimura M et al (2017) Late referrals to home palliative care service affecting death at home in advanced cancer patients in Japan: a nationwide survey. Ann Oncol 22(9):2113–2120

    Article  Google Scholar 

  9. Pivodic L, Pardon K, Van den Block L et al (2013) Palliative care service use in four European countries: a cross-national retrospective study via representative networks of general practitioners. PLoS ONE 8(12):e84440

    Article  Google Scholar 

  10. Yamagishi A, Morita T, Kawagoe S et al (2015) Length of home hospice care, family-perceived timing of referrals, perceived quality of care, and quality of death and dying in terminally ill cancer patients who died at home. Support Care Cancer 23(2):491–499

    Article  Google Scholar 

  11. Dhollander N, De Vleminck A, Deliens L et al (2019) Barriers to the early integration of palliative home care into the disease trajectory of advanced cancer patients: a focus group study with palliative home care teams. Eur J Cancer Care (Engl) 28(4):e13024

    Article  Google Scholar 

  12. Dhollander N, Deliens L, Van Belle S et al (2018) Differences between early and late involvement of palliative home care in oncology care: a focus group study with palliative home care teams. Palliat Med 32(7):1275–1282

    Article  Google Scholar 

  13. Morita T, Kizawa Y (2013) Palliative care in Japan: a review focusing on care delivery system. Curr Opin Support Palliat Care 7(2):207–215

    Article  Google Scholar 

  14. Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 19(6):349–357

    Article  Google Scholar 

  15. Davis MP, Temel JS, Balboni T et al (2015) A review of the trials which examine early integration of outpatient and home palliative care for patients with serious illnesses. Ann Palliat Med 4(3):99–121

    PubMed  Google Scholar 

  16. Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101

    Article  Google Scholar 

  17. Clarke V, Braun V (2013) Successful qualitative research: a practical guide for beginners. Sage, London

    Google Scholar 

  18. The AM, Hak T, Koëter G et al (2000) Collusion in doctor-patient communication about imminent death: an ethnographic study. BMJ 321(7273):1376–1381

    CAS  Article  Google Scholar 

  19. Horlait M, Chambaere K, Pardon K et al (2016) What are the barriers faced by medical oncologists in initiating discussion of palliative care? A qualitative study in Flanders, Belgium. Support Care Cancer 24(9):3873–3881

    CAS  Article  Google Scholar 

  20. van Riet PJ, Vernooij-Dassen M, Brouwer F et al (2014) Improving the organization of palliative care: identification of barriers and facilitators in five European countries. Implem Sci: IS 9:130

    Article  Google Scholar 

  21. Hui D, Mori M, Watanabe SM et al (2016) Referral criteria for outpatient specialty palliative cancer care: an international consensus. Lancet Oncol 17(12):e552–e559

    Article  Google Scholar 

  22. Morita T, Miyashita M, Yamagishi A et al (2013) Effects of a programme of interventions on regional comprehensive palliative care for patients with cancer: a mixed-methods study. Lancet Oncol 14(7):638–646

    Article  Google Scholar 

Download references


We acknowledge Dr. Kato Masashi. We thank all healthcare professionals who participated in this study. We also thank Audrey Holmes, MA, from Edanz (, for editing a draft of this manuscript.


This work was supported by Ministry of Health, Labor, and Welfare of Japan (Program Grant Number 20EA1028).

Author information

Authors and Affiliations



All authors were investigators in this study and participated in the study design, interpretation of the study results, and in the drafting, critical revision, and approval of the final version of the manuscript.

Corresponding author

Correspondence to Takaaki Hasegawa.

Ethics declarations

Ethics approval

The proposal for this study was submitted for approval to the Institutional Review Board and Ethics Committee of Nagoya City University Graduate School of Medical Science.

Consent to participate

All participants provided written informed consent.

Consent for publication

Participants consented to the submission of this research for publication.

Conflict of interest

AY is the Chairman of Research Association for Community Health.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hasegawa, T., Yamagishi, A., Sugishita, A. et al. Integrating home palliative care in oncology: a qualitative study to identify barriers and facilitators. Support Care Cancer 30, 5211–5219 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Neoplasms
  • Early palliative care
  • Palliative home care
  • Delivery of healthcare
  • Integrated
  • Medical oncology
  • Qualitative research