Skip to main content

Advertisement

SpringerLink
Log in

What are the barriers faced by medical oncologists in initiating discussion of palliative care? A qualitative study in Flanders, Belgium

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Introduction

Before referring patients to a palliative care service, oncologists need to inform them about disease stage and discuss prognosis, treatment options and possible advantages of specialized palliative care (SPC). They often find this a complex and emotionally difficult task. As a result, they may refer their patients to SPC too late in the disease course or even not at all. This study reports findings from interviews with Belgian medical oncologists identifying the barriers they experience to introduce palliative care to their patients with advanced cancer.

Methods

The interviews were semi-structured with open-ended questions and were supported by a topic list. The transcripts 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 which discourage oncologists from discussing palliative care: oncologist-related barriers, patient-related barriers, family-related barriers, barriers relating to the physician referring the patient to the medical oncologist, barriers relating to disease or treatment, institutional/organizational barriers and societal/policy barriers. These categories are further refined into subcategories.

Discussion

These findings provide an explanation for the possible reasons why medical oncologists feel hampered in initiating palliative care and consequently discuss it rather late in the disease trajectory. The exploration and description of these barriers may serve as a starting point for revising the medical education of oncologists. They are also a reminder to hospital management and policy makers to be aware of the impact of these barriers on the daily practice of oncology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lee YJ, Yang J-H, Lee J-W, et al. (2014) Association between the duration of palliative care service and survival in terminal cancer patients. Support Care Cancer 23:1057–1062. doi:10.1007/s00520-014-2444-4

    Article  PubMed  Google Scholar 

  2. Temel JS, Greer JA, Muzikansky A, et al. (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:733–742. doi:10.1056/NEJMoa1000678

    Article  CAS  PubMed  Google Scholar 

  3. Bakitas M, Lyons KD, Hegel MT, et al. (2009) Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the project ENABLE II randomized controlled trial. JAMA 302:741–749. doi:10.1001/jama.2009.1198

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Zimmermann C, Swami N, Krzyzanowska M, et al. (2014) Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet 383:1721–1730. doi:10.1016/S0140-6736(13)62416-2

    Article  PubMed  Google Scholar 

  5. Greer JA, Jackson VA, Meier DE, Temel JS (2013) Early integration of palliative care services with standard oncology care for patients with advanced cancer. CA Cancer J Clin 63:349–363. doi:10.3322/caac.21192

    Article  PubMed  Google Scholar 

  6. Peppercorn JM, Smith TJ, Helft PR, et al. (2011) American society of clinical oncology statement: toward individualized care for patients with advanced cancer. J Clin Oncol 29:755–760. doi:10.1200/JCO.2010.33.1744

    Article  PubMed  Google Scholar 

  7. Charalambous H, Pallis A, Hasan B, O’Brien M (2014) Attitudes and referral patterns of lung cancer specialists in Europe to specialized palliative care (SPC) and the practice of early palliative care (EPC). BMC Palliat Care 13:59. doi:10.1186/1472-684X-13-59

    Article  PubMed  PubMed Central  Google Scholar 

  8. Beernaert K, Cohen J, Deliens L, et al. (2013) Referral to palliative care in COPD and other chronic diseases: a population-based study. Respir Med 107:1731–1739. doi:10.1016/j.rmed.2013.06.003

    Article  PubMed  Google Scholar 

  9. Wentlandt K, Krzyzanowska MK, Swami N, et al. (2012) Referral practices of oncologists to specialized palliative care. J Clin Oncol 30:4380–4386. doi:10.1200/JCO.2012.44.0248

    Article  PubMed  Google Scholar 

  10. Hui D, Kim S-H, Kwon JH, et al. (2012) Access to palliative care among patients treated at a comprehensive cancer center. Oncologist 17:1574–1580. doi:10.1634/theoncologist.2012-0192

    Article  PubMed  PubMed Central  Google Scholar 

  11. Johnson C, Paul C, Girgis A, et al. (2011) Australian general practitioners’ and oncology specialists’ perceptions of barriers and facilitators of access to specialist palliative care services. J Palliat Med 14:429–435. doi:10.1089/jpm.2010.0259

    Article  PubMed  Google Scholar 

  12. Cherny NI, Catane R (2003) Attitudes of medical oncologists toward palliative care for patients with advanced and incurable cancer: report on a survery by the European Society of Medical Oncology Taskforce on palliative and supportive care. Cancer 98:2502–2510. doi:10.1002/cncr.11815

    Article  PubMed  Google Scholar 

  13. Quill TE (2000) Initiating end-of-life discussions with seriously ill patients. JAMA 284:2502–2507. doi:10.1001/jama.284.19.2502

    Article  CAS  PubMed  Google Scholar 

  14. Fallowfield L, Lipkin M, Hall A (1998) Teaching senior oncologists communication skills: results from phase I of a comprehensive longitudinal program in the United Kingdom. J Clin Oncol 16:1961–1968

    CAS  PubMed  Google Scholar 

  15. Corbin J, Strauss A (2014) Basics of qualitative research: techniques and procedures for developing grounded theory. SAGE Publications, Beverly Hills

    Google Scholar 

  16. van Kleffens T, Van Baarsen B, Hoekman K, Van Leeuwen E (2004) Clarifying the term “palliative” in clinical oncology. Eur J Cancer Care (Engl) 13:263–271. doi:10.1111/j.1365-2354.2004.00481.x

    Article  Google Scholar 

  17. Sepúlveda C, Marlin A, Yoshida T, Ullrich A (2002) Palliative care: the World Health Organization’s global perspective. J Pain Symptom Manag 24:91–96

    Article  Google Scholar 

  18. Lynn J, Adamson DM (2003) Living well at the end of life. Adapting health care to serious chronic illness in old age

  19. Meyers FJ, Linder J, Beckett L, et al. (2004) Simultaneous care: a model approach to the perceived conflict between investigational therapy and palliative care. J Pain Symptom Manag 28:548–556. doi:10.1016/j.jpainsymman.2004.03.002

    Article  Google Scholar 

  20. Hui D, Parsons H, Nguyen L, et al. (2010) Timing of palliative care referral and symptom burden in phase 1 cancer patients. Cancer 116:4402–4409. doi:10.1002/cncr.25389

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fallowfield L, Jenkins V (1999) Effective communication skills are the key to good cancer care. Eur J Cancer 35:1592–1597. doi:10.1016/S0959-8049(99)00212-9

    Article  CAS  PubMed  Google Scholar 

  22. Eelen S, Bauwens S, Baillon C, et al. (2014) The prevalence of burnout among oncology professionals: oncologists are at risk of developing burnout. Psychooncology 23:1415–1422. doi:10.1002/pon.3579

    Article  CAS  PubMed  Google Scholar 

  23. Shanafelt TD, Gradishar WJ, Kosty M, et al. (2014) Burnout and career satisfaction among US oncologists. J Clin Oncol 32:678–686. doi:10.1200/JCO.2013.51.8480

    Article  PubMed  PubMed Central  Google Scholar 

  24. Pollak KI, Arnold RM, Jeffreys AS, et al. (2007) Oncologist communication about emotion during visits with patients with advanced cancer. J Clin Oncol 25:5748–5752. doi:10.1200/JCO.2007.12.4180

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the BSMO for their support in recruiting participants and would like to thank all the participating oncologists. The authors would like to thank Stein Kaasa and Florian Strasser for their expert advice and Jane Ruthven for her language editing.

We thank Mark Leys for his valuable contribution and methodological assistance and we thank the editor and the anonymous reviewers for their insightful comments on the paper.

Author information

Authors and Affiliations

  1. End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Brussels, Belgium

    M. Horlait, K. Chambaere, K. Pardon & L. Deliens

  2. End-of-life Care Research Group, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium

    L. Deliens & S. Van Belle

  3. Department of Medical Oncology, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium

    S. Van Belle

Authors
  1. M. Horlait
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Chambaere
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Pardon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Deliens
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Van Belle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Horlait.

Ethics declarations

Conflict of interest

The authors have declared no conflict of interest. We have full control of all primary data and agree to the journal to review the data if requested.

Funding

This study was financially supported by the Research Foundation Flanders (FWO); Grant number: G035813N.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Horlait, M., Chambaere, K., Pardon, K. et al. What are the barriers faced by medical oncologists in initiating discussion of palliative care? A qualitative study in Flanders, Belgium. Support Care Cancer 24, 3873–3881 (2016). https://doi.org/10.1007/s00520-016-3211-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-016-3211-5

Keywords

Search

Navigation