Barriers to referral to inpatient palliative care units in Japan: A qualitative survey with content analysis

Objectives: We investigated the barriers to referral to inpatient palliative care units (PCUs) through a qualitative study across various sources of information, including terminal cancer patients, their families, physicians, and nurses. Materials and methods: There were 63 participants, including 13 advanced cancer patients, 10 family members, 20 physicians, and 20 nurses in palliative care and acute care cancer settings from five regional cancer institutes in Japan. Semi-structured interviews were conducted regarding barriers to referral to PCU, and data were analyzed by content analysis method. Results: A total of 21 barriers were identified by content analysis. The leading barriers were (1) a negative image of PCUs by patients and families (n=39), (2) delay of termination of anti-cancer treatment by physicians in the general wards (n=24), (3) unwillingness to end anti-cancer treatment and denial of the fatal nature of the disease by patients and families (n=22), (4) patient's wish to receive care from familiar physicians and nurses (n=20), and (5) insufficient knowledge of PCUs by medical staff in general wards (n=17). Conclusions: To correct these unfavorable images and misconceptions of PCUs, it is important to eliminate the negative image of PCUs from the general population, patients, families, and medical staffs. In addition, early introduction of palliative care options to patients and communication skills training regarding breaking bad news are relevant issues for a smooth transition from anti-cancer treatment to palliative care.