Barriers to Referral for Palliative Radiotherapy by Physicians: A Systematic Review.

Area of Science:

• Oncology
• Palliative Care
• Health Services Research

Background:

• Palliative radiotherapy (PRT) offers symptom relief and improves quality of life.
• PRT remains underutilized, with lack of referrals identified as a potential cause.

Purpose of the Study:

• To systematically review physician barriers impeding referral for palliative radiotherapy.

Main Methods:

• Searched EMBASE and MEDLINE for studies on physician barriers to PRT referral.
• Synthesized data by calculating the percentage of survey respondents identifying specific barriers.
• Categorized barriers using a conceptual framework for radiotherapy access.

Main Results:

• Eleven studies (12 cohorts) met inclusion criteria, primarily using cross-sectional surveys.
• Key barriers included physician unfamiliarity with risks/benefits, cumbersome referral processes, and treatment inconvenience.
• Other significant factors were patient wishes, functional status, life expectancy, treatment length, cancer type, benefit uncertainty, and toxicity concerns.

Conclusions:

• High-quality data on PRT referral barriers are limited to survey studies.
• Interventions should address physician knowledge gaps, streamline referral processes, and reduce perceived treatment inconvenience.
• Tailored strategies for different professional groups, including interprofessional education, are recommended to increase PRT referrals.