Clinician Perspectives on Palliative Care for People with Hepatocellular Carcinoma: Facilitators of and Barriers to Referral

SIMPLE SUMMARY: Hepatocellular carcinoma (HCC) is the most common type of liver cancer. HCC is difficult to cure and rates are rising. Treatment advances over the last decade have led to people living longer with HCC. Palliative care services offer potential additional support, but they receive referrals infrequently compared with other cancers. We need a better understanding of when these teams do and do not make palliative care referrals. We interviewed HCC-treating clinicians and found a number of relevant factors that impact referral. They refer at times of transition, for help with certain symptoms, and for additional support. They hesitate to refer because of lack of availability or too many appointments for the patient, not knowing who is appropriate, presence of symptoms they can manage themselves, and worry that the patient will think they have lost hope. These findings can be addressed when developing future palliative care programs for people with HCC. ABSTRACT: (1) Background: Little is known about facilitators of and barriers to palliative care referral for people with hepatocellular carcinoma (HCC). The objective of this study is to identify facilitators and barriers of palliative care referral described by HCC-treating clinicians. (2) Methods: Semi-structured interviews (n = 16) were conducted with HCC-treating clinicians at two centers, focusing on referral patterns, palliative care needs, and disease course. A code book was created, axial coding was used to code all interviews, and selective coding was used to identify facilitators and barriers of palliative care referral. (3) Results: Facilitators included helpfulness at times of transition; help with management of certain symptoms; provision of psychosocial support; and positive experiences with referral. Barriers included feasibility concerns; lack of information about palliative care and who is appropriate; lack of symptoms requiring outside referral; and concerns that palliative care conveys loss of hope. (4) Conclusions: Participants noted the helpfulness of palliative care at specific points in the disease trajectory and cited barriers related to feasibility, lack of need, lack of awareness, and loss of hope. The results show actionable issues that can be addressed in future research to leverage the benefits of and overcome the barriers to palliative care for people with HCC.