BARRIERS to PALLIATIVE CARE

Many patients with advanced disease do not receive palliative care and some
are referred too late in the course of their disease to benefit from treatment.

The reasons for this may relate to the physician, the patient, the family, or to societal factors.

Barriers related to the physician
☛   poor prognostication: does not recognise how advanced the patient’s illness is
☛   may not recognise how much the patient is suffering
☛   lacks communication skills to address end-of-life issues
☛   believe they are already providing good palliative care and need no assistance
☛   misunderstands what a palliative care service does or has to offer
☛   does not want to hand over the patient’s care: loss of control, loss of income
☛   opiophobia: worries the patient may become addicted to opioids or suffer severe side effects
☛   does not believe in palliative care
☛   does not know of the palliative care service

Barriers related to the relatives
☛   they may never have heard of palliative care or a local service
☛   they may not know whom to ask about it
☛   they may worry if they can afford it
☛   they may fear what relatives and neighbours will say about home care
☛   they may not want many professionals visiting the home
☛   there may be patient-family disagreement about treatment options
☛   they may feel unskilled and unable to care for their loved one at home
☛   they may want the patient to stay at home or the hospital ward they are currently in
☛   they may fear unexpected emergencies at home and not know if the palliative care service can cope with them
☛   they may fear it may mean telling the patient they are dying (which may have been previously resisted)
☛   they may think it is euthanasia by another name

Barriers related to the patient
☛   they may have unrealistic expectations about their disease and prognosis
☛   there may have been no advance care planning/discussions
☛   they may not have heard of hospice or palliative care
☛   they may suspect that it is dismal, gloomy and frightening with people dying all around you and everyone talking about death
☛   they may suspect that people die as a result of euthanasia
☛   they may worry about opioid addiction
☛   they may not want to leave home or the unit they are currently in
☛   they may not want to have to develop relationships with new professionals

Barriers related to society and culture
☛   ethnic minorities
☛   language barriers
☛   poor or underprivileged
☛   rural communities
☛   dying and death still remain, to a large extent, taboo subjects
☛   there is still a deeply held view that maintaining life—whatever its quality—is a prime responsibility of health care professionals and services.
☛   opiophobia