Opportunity is the greatest barrier to providing palliative care to advanced colorectal cancer patients: a survey of oncology clinicians

Palliative care (PC) is part of the recommended standard of care for patients with advanced cancer. Nevertheless, delivery of PC is inconsistent. Patients who could benefit from PC services are often referred late-or not at all. In planning for improvements to oncology PC practice in our health care system, we sought to identify barriers to the provision of earlier PC, as perceived by health care providers managing patients with metastatic colorectal cancer (mcRc). We used the Michie Theoretical Domains Framework (TDF) and Behaviour Change Wheel (BCW), together with knowledge of previously identified barriers, to develop a 31-question survey. The survey was distributed by e-mail to MCRC health care providers, including physicians, nurses, and allied staff. Responses were obtained from 57 providers (40% response rate). The most frequently cited barriers were opportunity-related-specifically, lack of time, of clinic space for consultations, and of access to specialist PC staff or services. Qualitative responses revealed that resource limitations varied by cancer centre location. In urban centres, time and space were key barriers. In rural areas, access to specialist PC was the main limiter. Self-perceived capability to manage PC needs was a barrier for 40% of physicians and 30% of nurses. Motivation was the greatest facilitator, with 89% of clinicians perceiving that patients benefit from PC. Based on the Michie TDF and BCW model, interventions that best address the identified barriers are enablement and environmental restructuring. Those findings are informing the development of an intervention plan to improve oncology PC practices in a publicly funded health care system.