# Canada Cancer Clinicians’ Perceptions of Palliative Care in Pancreatic Cancer: A National Survey

## TL;DR

Canadian cancer doctors believe palliative care is important for pancreatic cancer but face barriers like patient reluctance and lack of knowledge, which could be addressed through education and better services.

## Contribution

Identifies specific barriers and facilitators to palliative care referral and access in pancreatic cancer as perceived by Canadian oncology clinicians.

## Key findings

- Most clinicians perceive patient-family reluctance as a major barrier to palliative care access and referral.
- Lack of knowledge about palliative care services is a significant barrier reported by 50% of participants.
- Patient education is seen as the main facilitator to improve palliative care acceptance and access.

## Abstract

Pancreatic cancer is an aggressive disease and a leading cause of cancer death; as such, people with pancreatic cancer benefit from palliative care early and alongside treatment. However, most are referred to palliative care by their oncology clinician, whose perceptions of palliative care can impact the timing and likelihood of referral. While the literature has previously explored patient–provider perceptions of palliative care, we do not know what barriers to referral and access are the most notable for pancreatic cancer providers in Canada. In this study, we surveyed oncology clinicians across Canada to understand perceived barriers and facilitators to referral and access; participants reported perceived patient-family reluctance to accept palliative care, lack of knowledge about palliative care services and lack of access to palliative care services as the main barriers and patient education the main facilitator. These insights highlight palliative care service expansion and education as areas for improving guideline-concordant pancreatic cancer care.

(1) Background: Pancreatic cancer causes significant morbidity and mortality, and guidelines recommend early integration of palliative care alongside active treatment. As access to palliative care is often mediated by oncology clinicians, this survey sought to understand these clinicians’ perspectives on barriers and facilitators to clinician palliative care referral and patient palliative care access. (2) Methods: An online survey was distributed via community and academic institutions across Canada to oncology clinicians who were able to refer a pancreatic cancer patient to palliative care (e.g., oncology nurses, medical oncologists). (3) Results: Of 134 clinicians from ten provinces, almost all (97%) believe that palliative care is ‘very important’ in pancreatic cancer care. The greatest perceived barriers to patient palliative care access included patient-family reluctance to accept palliative care (73%), lack of knowledge about services (50%), and lack of support from other healthcare professionals (40%). Perceived barriers to referring included patient-family reluctance to accept palliative care (57%) and lack of available specialist services (58%). Most providers suggested patient education as a strategy to overcome barriers (85%). (4) Conclusions: Perceptions about public acceptance may preclude oncology clinicians from referring to palliative care, despite nearly universal belief in its importance. The findings highlight service and education gaps for future intervention.