Understanding the Stigmatization of Palliative Care Referral in Oncology

Findings from a recent study suggest strategies for oncology clinicians to reduce the stigmatizing association of palliative care with end of life (JCO Oncol Pract. 2021; OP2100088. doi:10.1200/OP.21.00088).

“Palliative care can help patients with cancer manage symptoms and achieve a greater quality of life. However, there are many barriers to patients with cancer receiving referrals to PC [palliative care], including the stigmatizing association of PC [palliative care] with end of life,” wrote Taynara Formagini, MS, Department of Population Health, University of Kansas School of Medicine, Kansas City, and colleagues.

Ms Formagini and colleagues conducted this study to explore factors around the stigmatizing association between palliative care referrals and end of life in cancer care.

A qualitative descriptive design was developed to investigate barriers to palliative care referrals for patients receiving treatment at an outpatient cancer center. Audio-recordings of interviews with patients, caregivers, and oncology professionals, where participants were asked about perceptions of palliative care and palliative care referral experiences, were transcribed and independently coded by three investigators.

Among the 44 participants interviewed, prognostic uncertainty, confusion about palliative care's role, and social network influence were all factors linked to an inaccurate and stigmatizing association of palliative care with end of life.

Familiarity with palliative care, prognostic confidence, and clear referral communication aided in identifying palliative care and end of life care as separate things.

“To reduce the stigmatizing association of PC [palliative care] with end of life, referring clinicians should clearly communicate prognosis, PC's [palliative care’s] role, and the reason for referral within the context of each patient and his or her unique cancer trajectory,” concluded Ms Formagini and colleagues, adding, “The oncology team plays a vital role in framing the messaging surrounding referrals to PC [palliative care].”—Marta Rybczynski