Perceived Barriers Faced by Puerto Rican Oncologists During Goals-of-Care Discussions With Patients With Advanced...

Timely discussion of goals of care (GoC) between oncologists and patients with advanced cancer can improve end-of-life (EoL) decision making, ensuring that care aligns with individual preferences. However, barriers at multiple levels could limit timely EoL communication. This cross-sectional study examined oncologists' perceptions of barriers to GoC discussions regarding EoL processes among patients in Puerto Rico.

A 26-item questionnaire was distributed to oncologists in Puerto Rico, assessing three barrier domains (patient and family; physician; and systemic or external factors) and oncologists' willingness to engage in GoC discussions. Data were collected between April 2024 and January 2025. Descriptive statistics were used to summarize oncologists' characteristics. Differences in oncologists' characteristics and willingness to engage in the decision-making process were assessed with the Mann-Whitney test (non-normally distributed data). Associations between barriers and oncologists' characteristics, such as age and training, were explored.

A total of 60 oncologists across Puerto Rico (approximately 50% participation rate) completed the questionnaire. Over 65% identified patient- and family-related factors as the primary barriers to EoL discussions. Although 58.3% of oncologists had not received formal training in EoL, they did not perceive this as a significant barrier. Yet, those without formal training faced greater barriers.

Family and patient factors emerged as the predominant barriers. Despite oncologists' willingness to engage in EoL discussions, the absence of formal training may hinder these conversations. Further research should focus on communication training and initiatives to provide oncologists, patients, and families with valuable resources for EoL decision making.