1. What are the barriers for medical oncologists to initiate a palliative care discussion to their incurable patients? A qualitative interview study in Flanders, Belgium Melissa Horlait

2. Context Specialised palliative care (SPC) SPC for advanced cancer
Positive effect on QoL (quality of life)
Positive effect on survival time
SPC for advanced cancer
Oncologists refer their advanced cancer patients (too) late in their disease course
Before referring patients to SPC  open en realistic discussion about disease stage, prognosis, treatment options and advantages of SPC

3. Research Question
What are possible barriers for (Flemish) medical oncologists to initiate SPC (for the first time) to their advanced cancer patients?

4. Methods Qualitative interview study
Explorative, open, face-to-face interviews
Grounded Theory approach

5. Results 82 letters of invitation
15 certified medical oncologists from academic and non-academic hospitals in Flanders
11 male and 4 female
5 from an academic hospital and 10 from a non-academic hospital
Age range: 37 to 70 years
Work experience: 8 to 44 years
Average duration of the interviews: minutes

6. Categories Oncologist related barriers Patient related barriers
Family related barriers
Barriers related to the referring physician
Barriers related to disease or treatment
Institutional/organisational barriers
Societal/policy barriers

7. Oncologist related barriers
Lack of training and education
In communciation skills
In palliative care
Feeling of failure
Fear of depriving hope

8. Patient related barriers
Emotions (sadness/anger)
Unrealistic expectations
Unrealistic trust and faith in medicine
Giving up hope

9. Family related barriers
Protection of the patient
Unrealistic expectations/disagreement about goals of care and treatment
Emotional reactions

10. Barriers related to the referring physician
Lack of agreement for referral to the medical oncologist
Late referral
Reluctance to discuss disease stage

11. Barriers related to disease or treatment
Therapeutic options/phase 1 trails
Inability to estimate prognosis
Unexpected/unpredictable progression

12. Institutional/organisational barriers
Availibility of palliative care
Practical organisation
Workload
Lack of support/coaching for oncologists

13. Societal and policy barriers
Palliative care stigma
Negative connotation palliative care
Misunderstandig concept palliative care
Education and training
Lack of integration of palliative care in medical education
Lack of CST for medical oncology
Predominance of the curative model

14. Conclusions
Oncologists still entertain the ‘old’ concept of palliative care
This concept of palliative care is still predominant among patients, families and on societal level
Lack of training in communication skills during their medical training
Lack of support and coaching for medical oncologists

15. Conclusions

16. Contact mhorlait@vub.ac.be End-of-life Care Research Group
Vrije Universiteit Brussel & Ghent University
Faculty of Medicine
Laarbeeklaan 103
B-1090 Brussels (Belgium)

17. Thank you for your attention!