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

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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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.

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Acknowledgements

We acknowledge Dr. Kato Masashi. We thank all healthcare professionals who participated in this study. We also thank Audrey Holmes, MA, from Edanz (https://jp.edanz.com/ac), for editing a draft of this manuscript.

Funding

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

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Authors and Affiliations

Authors

Contributions

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.

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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). https://doi.org/10.1007/s00520-022-06950-6

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  • DOI: https://doi.org/10.1007/s00520-022-06950-6

Keywords

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