Perceived Barriers to Goals of Care Discussions With Patients With Advanced Cancer and Their Families in the Ambulatory Setting

• DOI: 10.1177/0825859718762287
• Publication Date: 2018-04-02T11:13:41Z
• Authors: Josee-Lyne Ethier; Thivaher Paramsothy; John J. You; Robert Fowler; Sonal Gandhi
• Keywords: Adult; Male; Oncologists; Ontario; Physician-Patient Relations; Terminal Care; Attitude of Health Personnel; Communication Barriers; Palliative Care; Patient Preference; Middle Aged; Patient Care Planning; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Neoplasms; Surveys and Questionnaires; Ambulatory Care; Humans; Family; Female

Earlier goals of care (GOC) discussions in patients with advanced cancer are associated less aggressive end-of-life including decreased use medical technologies. Unfortunately, conversations often occur late the disease trajectory when acutely unwell. Here, we evaluate practitioner perspectives patient, family, physician, and external barriers to early GOC ambulatory oncology setting.A previously published survey assess among clinicians on inpatient wards was modified for setting distributed oncologists from 12 centers Ontario, Canada. Physicians were asked rank importance various having (1 = extremely unimportant 7 important).Questionnaires completed by 30 (24%) 127 physicians. Respondents perceived patient- family-related factors as most important discussions. Of these, patient difficulty accepting prognosis or desire treatment important. Patients' inflated expectation benefit also considered an barrier discontinuing active cancer-directed therapy. While physician ranked lower than patient-related factors, clinicians' self-identified estimating uncertainty regarding benefits Patient's refusal referral highly rated palliative referral. Most respondents nonetheless very willing initiate (90%) lead (87%) discussions.Oncologists discussions, while Further work is required preferences perceptions develop targeted interventions.