The transition from oncology to palliative care: barriers and facilitators explored through an integrative review.

Abstract

Background: Patients with advanced cancer often experience difficult symptoms near the end of life, yet the beneficial integration of oncology and palliative care is frequently lacking or poorly coordinated. Transitioning from curative treatments to palliative care focused on symptom relief and quality of life remains a common challenge. Palliative care is often underused or introduced late in the cancer treatment process, leading to suboptimal care outcomes. Understanding the factors influencing this transition is crucial for improving patients' overall care experience. This review aims to explore barriers and facilitators involved in a comprehensive transition process from oncology to palliative care of patients with advanced cancer.

Methods: This integrative review explored empirical research from 2010 to 2023 sourced from PubMed, PsycINFO, CINAHL and Cochrane databases, adhering to PRISMA guidelines. Search strategy combined concepts of advanced cancer, transition in palliative care, palliative care, and barriers and facilitators. Blind review software facilitated article selection based on criteria, with data extracted using a predefined sheet. Themes were identified through inductive thematic analysis.

Results: 38 studies met inclusion criteria out of 180 screened records. These studies were conducted in 13 countries and data collection methods ranged from interviews and focus groups to surveys and analysis of electronic medical records. In the analysis, six key themes emerged: (1) knowledge and understanding about the disease trajectory and palliative care, (2) cultural aspects of providing palliative care, (3) shortcomings in economic coverage for services, (4) characteristics of the patients' clinical situation, (5) relational dynamics between patients and professionals and among professionals and (6) organisational issues involving limitations and fragmentation of care.

Conclusions: This review highlights the multifaceted factors affecting the transition to palliative care. Addressing these challenges requires improvements in communication, cultural competence, financial support and organisational structure. Effective integration of palliative care into oncology practices requires collaboration among various stakeholders, including healthcare professionals, policymakers, patients, and caregivers. Through enhanced education initiatives, a more patient-centric approach to managing advanced cancer can be achieved.