Navigating the Border - How Swedish Physicians Approach Palliative Care Referrals in Oncology

IntroductionEarly integration of palliative care (PC) alongside oncology care is widely recognised as beneficial for patients and their next of kin. Sharing the responsibility with colleagues can ease the burden for the physician. However, according to our previous research with physicians, while two out of three expressed a positive attitude towards early integration of PC, only one-third actually implemented it. To facilitate the early integration of PC, the physicians' own attitudes need to be highlighted. The aim of this study was to explore Swedish physicians' personal experiences and their view of the role of the organisation when referring patients with cancer to PC.MethodsA study was performed using a study-specific questionnaire. Physicians working with cancer patients within different specialties participated. Data were collected in a cross-sectional online survey. Quantitative data (items) were analysed using descriptive statistics and open-ended responses were analysed with thematic analysis.ResultsIn total, 130 physicians participated. The majority reported feeling confident when introducing PC to patients (97.6%) They expressed a high degree of medical and emotional relief when the patients were enrolled in PC. Organisational challenges were reported in gaining acceptance from PC providers (50.9%) and in ensuring equal access to PC (54.5%). Thematic analysis identified multifaceted aspects related to navigating barriers and facilitators in the referral process, the benefits achieved from mutual collaboration with PC providers, and the physician related challenges when managing the organisational labyrinth.ConclusionThe physicians expressed confidence in discussing PC with patients. They experienced personal, professional, patient-related and organisational benefits when patients were enrolled in PC. A majority expressed that the patients did not have equal access to PC. To reach this goal, organisational aspects, including communication pathways and geographical restrictions, need to be addressed.