Barriers for referring to exclusive palliative care: the oncologist’s perception

ABSTRACT

Patients with advanced cancer demand palliative care. Our objective was to assess the barriers for referral to the palliative care in the perception of oncologists. In a study with the oncologists from a national reference institution who were asked about aspects related to their academic background, the understanding of the meanings of palliative care, as well as limits and benefits the referral of patients to an exclusive palliative care unit. Qualitative analysis was performed using Bardin’s content analysis. Nineteen oncologists participated. Despite defining the palliative care with multidisciplinary characteristics, aimed at advanced disease, with the objective of improving quality of life, they reported difficulties in the referral, related to the professional, expectations of patients/relatives, therapeutic obstinacy and institutional characteristics. The creation of a ‘Consulting Team’ in the usual care units was the main strategy reported as a facilitator potential for this care transition. We concluded that the deliberation of the exclusive palliative care for patients with advanced cancer is a difficult task, which goes through different barriers, which can result in a late referral. The dichotomy that exists between ‘treatment’ and ‘palliative care’ in the exclusive palliative care must be rethought, opposing the idea of palliative care offered from diagnosis.

KEYWORDS
Palliative care; Oncology; Neoplasms; Physician-patient relations; Hospice care