Structural barriers to timely palliative care conversations in oncology: An audio-diary study
Abstract
Background: Timely communication about palliative care (PC) is essential to ensure early, patient-centred integration of PC into cancer care. In practice, uncertainty about when and how to initiate these conversations contributes to delays and missed opportunities for holistic support.
Aim: To explore factors that enable or hinder timely palliative care conversations in oncology.
Methods: We conducted a qualitative audio-diary study (n = 28 entries) including ten healthcare professionals (oncologists, haematologists, nurses, psycho-oncologists, and coordinators) in an Austrian hospital. Participants recorded event-based diaries during or after shifts using a data‑secure mobile app, documenting key communication events (e.g., prognosis discussions, goal‑of‑care discussions, and (non-)referrals to PC). Audio entries were transcribed and thematically analysed.
Results: Participants reported a dominant curative focus that fostered continuation of active treatment, while PC was framed as “failure”. They described patient/family resistance to PC discussions due to stigma and misconceptions linking PC to imminent death and diminished control. Participants reported uncertainty about who should initiate PC conversations, and which PC pathway fits individual cases. Thorough counselling about PC was viewed as challenging and time-consuming, with insufficient formal recognition. It was noted that existing systems do not provide dedicated fields to document these conversations. Hierarchical dynamics were seen as inhibiting early PC conversations. Participants wished for more open, non-hierarchical, interprofessional dialogue to normalise timely PC involvement.
Conclusions: Delays in PC communication reflect structural barriers including time pressure, ambiguous roles and responsibilities, limited recognition and documentation of counselling, and knowledge gaps. To enable earlier PC integration, actions should target PC triggers, documentation, training, and referral pathways.
Key messages: • Timely conversations about palliative care are often delayed by structural barriers such as stigma, unclear responsibilities, hierarchy, time pressure, and lack of documentation/recognition.
• Early palliative care integration in cancer care needs clear triggers, defined roles and referral pathways, better training and documentation, and open, non-hierarchical interprofessional dialogue.
Related
- Collaborative Solutions to Identify Scheduling Barriers for Timely Post-Hospital Discharge Primary Care Follow-Up: A Quality Improvement Initiative
- Identifying patient-centered communication barriers in palliative care.
- Palliative care in chronic heart failure in the Netherlands: practices, competencies and barriers among hospital-based healthcare professionals : From the Working Group of Palliative Care of the Netherlands Society of Cardiology (NVVC).
- Enhancing oncology nursing capacity in Cameroon: A mixed-methods evaluation of a palliative and psychosocial care training program
- Working conditions, career barriers and perceived equity among neuro-oncology professionals: insights from the Japan society for neuro-oncology (JSNO) gender equality and diversity committee survey
BibTeX
@article{lorenzoni2026structural,
title = {{Structural barriers to timely palliative care conversations in oncology: An audio-diary study}},
author = {N Lorenzoni and L Ringel and C Kreyer},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.627},
url = {https://doi.org/10.1093/eurpub/ckag169.627},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Structural barriers to timely palliative care conversations in oncology: An audio-diary study
AU - N Lorenzoni
AU - L Ringel
AU - C Kreyer
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.627
UR - https://doi.org/10.1093/eurpub/ckag169.627
AB - Background: Timely communication about palliative care (PC) is essential to ensure early, patient-centred integration of PC into cancer care. In practice, uncertainty about when and how to initiate these conversations contributes to delays and missed opportunities for holistic support. Aim: To explore factors that enable or hinder timely palliative care conversations in oncology. Methods: We conducted a qualitative audio-diary study (n = 28 entries) including ten healthcare professionals (oncologists, haematologists, nurses, psycho-oncologists, and coordinators) in an Austrian hospital. Participants recorded event-based diaries during or after shifts using a data‑secure mobile app, documenting key communication events (e.g., prognosis discussions, goal‑of‑care discussions, and (non-)referrals to PC). Audio entries were transcribed and thematically analysed. Results: Participants reported a dominant curative focus that fostered continuation of active treatment, while PC was framed as “failure”. They described patient/family resistance to PC discussions due to stigma and misconceptions linking PC to imminent death and diminished control. Participants reported uncertainty about who should initiate PC conversations, and which PC pathway fits individual cases. Thorough counselling about PC was viewed as challenging and time-consuming, with insufficient formal recognition. It was noted that existing systems do not provide dedicated fields to document these conversations. Hierarchical dynamics were seen as inhibiting early PC conversations. Participants wished for more open, non-hierarchical, interprofessional dialogue to normalise timely PC involvement. Conclusions: Delays in PC communication reflect structural barriers including time pressure, ambiguous roles and responsibilities, limited recognition and documentation of counselling, and knowledge gaps. To enable earlier PC integration, actions should target PC triggers, documentation, training, and referral pathways. Key messages: • Timely conversations about palliative care are often delayed by structural barriers such as stigma, unclear responsibilities, hierarchy, time pressure, and lack of documentation/recognition. • Early palliative care integration in cancer care needs clear triggers, defined roles and referral pathways, better training and documentation, and open, non-hierarchical interprofessional dialogue.
SN - 1101-1262
SN - 1464-360X
ER -