Background: Earlier goals of care (GOC) discussions in patients with advanced cancer are associated with less aggressive end-of-life (EOL) care and with better quality of life near death. Despite that, these discussions do not always occur between oncologists and their patients.
Objectives: To evaluate oncologists' agendas concerning EOL discussions and advanced directive (AD), and to identify barriers to these discussions.
Methods: The study included oncologists from Israeli hospitals who were asked to complete a questionnaire in order to assess barriers to EOL conversations. The questionnaire was adapted from Canadian research among clinicians in medical wards. Participants were asked to rank the importance of the various barriers.
Results: The questionnaires were completed by 84 physicians. Most physicians in this group (97%) thought it was important to have discussions on GOC with the patient, and 67% thought it was important that the patient would sign an AD form. Respondents perceived patient and family-related factors as the most important barriers. Of these, the most important were the patients' and patients' families difficulty accepting their poor prognosis, rated as important by 90% and 78% respectively, and the patients' difficulty understanding the limitations and complications of life-sustaining treatments, rated as an important by 81% of respondents. While physicians and system factors were ranked lower than patient-related factors, time limitations and desire to maintain hope were also considered important, 80% and 74% respectively.
Conclusions: Oncologists ranked patient and family-related factors as the most important barriers to GOC discussions. Time limitations and the desire to maintain hope were also considered important.
Discussion: Further work is required to assess patient preferences and perceptions and to develop targeted interventions.