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Table 2 Characteristics of the selected studies

From: Palliative care utilization in oncology and hemato-oncology: a systematic review of cognitive barriers and facilitators from the perspective of healthcare professionals, adult patients, and their families

*Study no.Author/s and yearAimDesignParticipants and originData collection method
1Akiyama, M., Takebayashi, T., et al., 2012 [20]To assess patients’ knowledge, beliefs, or concerns about opioids, palliative care (PC), and homecareQuantitative – Survey study925 outpatients with metastatic or recurrent cancer - JapanQuestionnaire (mail paper form)
2Alaeddini, J., Julliard, K., et al., 2000 [21]To explore physicians’ attitudes and opinions about PC and its implementationQualitative23 physicians (community primary care physicians, hospital-based ambulatory clinic physicians, and specialists) - USAFocus-group
3Ansari, M., Rassouli, M.,et al., 2018 [22]To explore the educational needs of stakeholders of palliative care for cancer patientsQualitative20 participants: cancer patients
and their caregivers; healthcare
providers, experts and policy-makers active in the field of cancer - Iran
Semi-structured interview
4Beernaert, K., Deliens, L., et al., 2014 [23]To examine barriers and facilitators of the early identification of PC needs by family physicians (FP)Qualitative20 FP, 12 community and PC
nurses, 18 patients - Belgium
Focus-group and semi-structured interview
5Boyd, D., Merkh, K., et al., 2011 [24]To identify oncology nurses’ attitudes toward care at the end of life and PC useQuantitative – Cross-sectional, descriptive correlational survey study31 oncology nurses - USAQuestionnaire
6Bradley, E. H., Cramer, L. D., et al., 2002 [89]To identify physicians’ characteristics associated to referral to PCQuantitative - Cross-sectional study231 physicians (internists, family physicians, oncologists, pulmonologists, and cardiologists) - USAQuestionnaire
7Broom, A., Kirby, E. et al., 2012 [25]To examine the logics underpinning the timing of referral to PCQualitative20 medical specialists (oncology, urology, haematology, geriatrics, general medicine, nonspecialist palliative medicine) - AustraliaSemi-structured interview
8Canzona, M. R., Love, D., et al., 2018 [26]To investigate challenges that nurses face when they provide care for oncological patients transitioning from curative to palliative care and to identify educational opportunities for nursesQualitative Mixed28 nurses (14 practicing in oncology and 14 practicing in palliative care) - USASemi-structured interview (telephone)
9Cherny, N. I. and Catane, R., 2003 [27]To identify oncologist-related barriers to the provision of optimal supportive and PCQuantitative – Cross-sectional survey study895 oncologists (members of the European Society of Medical Oncology) – Europe (82.5%), America (12.1%), Australia (2.2%), Asia (2.6%) and Africa (0.7%).Questionnaire
10Feeg, V. D. and Elebiary, H., 2005 [28]To explore professionals’ perceptions about barriers related to hospice and PC, opinions about barriers related to dying at home, and barriers related to advance directivesQuantitative – Cross-sectional survey100 national conference on PC attendees (nurses 71%, social workers 11%, hospital/hospice administrators 6%, physicians 4%, counselors 3%, chaplains 3%, and physical therapists 2%) - USAQuestionnaire
11Fox, J., Windsor, C. et al., 2016 [29]To explore the transition to PCQualitative29 participants:
patients, family carers, and healthcare professionals - Australia
Semi-structured interview
12Gidwani, R., Nevedal, A., et al., 2017 [30]To characterize oncologists’ perceptions of primary and specialist PC; experiences interacting with PC specialists; and the optimal interface of PC and oncology in providing PCQualitative31 oncologists -USASemi-structured interview (telephone)
13Gott, M., Ingleton, C. et al., 2011 [31]To explore how transitions to a PC
approach are perceived to be managed in acute hospital settings
Qualitative58 health professionals (involved in the
provision of PC) – United Kingdom
Focus group and interview
14Groot, M. M., Vernooij-Dassen, M. J. et al., 2005 [32]To investigate general practitioners’ task perception and barriers involved in PCQualitative12–33 general practitioners (non specified the exact number) – The NetherlandsFocus-group
15Miyashita, M., Hirai, K. et al., 2008 [33]To investigate the barriers to referral to inpatient PC unitsQualitative63 participants (13 advanced cancer patients, 10 family members, 20 physicians, and 20 nurses in PC and acute care cancer settings) - JapanSemi-structured interview
16Horlait, M., Chambaere, K. et al., 2016 [34]To identify the barriers that oncologists experience to introduce PC to patientsQualitative15 oncologists BelgiumSemi-structured interview
17Hui, D., Cerana, M. A. et al., 2016 [35]To examine the association between oncologists’ end of life care attitudes and timely specialist PC referralQuantitative – Cross-sectional240 oncology specialists (120 hematologic and 120 solid oncology specialists) – USAQuestionnaire
18Hui, D., Park, M. et al., 2015 [37]To examine the differences in attitudes and beliefs toward PC referral
between hematologic and solid tumor specialists
Quantitative - Cross-sectional240 oncology specialists (120 hematologic and 120 solid oncology specialists) – USAQuestionnaire
19Johnson, C., Paul, C. et al., 2011 [74]To explore doctors’ perceptions of barriers to referring patients for specialized PC.Qualitative – Exploratory study40 medical doctors (general practitioners, oncologists, radiation oncologists, hematologists, respiratory physicians and colorectal surgeons) - AustraliaInterview (telephone)
20Kafadar, D., Ince, N. et al., 2015 [38]To evaluate the managerial perspectives and opinions about specialized PCMixed method70 medical directors - TurkeyQuestionnaire
21Kawaguchi, S., Mirza, R. et al., 2017 [39]To explore medical doctors’ understanding of and experiences with PCQualitative10 internal medicine residents - CanadaSemi-structured interview
22Keim-Malpass, J., Mitchell, E. M. et al., 2015 [40]To identify existing barriers in accessing PC services for cancer patientsQualitative42 clinicians, administrative support staff, and service support personnel - USASemi-structured interview
23Kirby, E., Broom, A. et al., 2014 [41]To examine how medical specialist conduct the process of negotiation of the transition to specialist PC with familiesQualitative20 medical specialists (e.g. medical oncology, haematology, surgery, radiation oncology, general medicine, geriatrics, etc.) AustraliaSemi-structured interview
24Kumar, P., Casarett, D. et al., 2012 [42]To identify barriers to supportive and PC services among oncology outpatientsQuantitative - Cross-sectional313 patients with breast, lung or gastrointestinal cancer - USAQuestionnaire
25Le, B. H., Mileshkin, C., L. et al., 2014 [77]To explore lung cancer clinicians’ perceptions of PC and to identify views, barriers and benefits of referring to PCQualitative28 clinicians (involved in the management of patients with lung cancer) - AustraliaFocus group and semi-structured interview
26Le, B. H. C. and Watt, J. N., 2010d [43]To assess care provided to patients dying and to understand
senior clinician decision-making around referral to PC
Mixed method27 (senior) clinicians - AustraliaA retrospective chart-audit and semi structured interview
27LeBlanc, T. W., O’Donnell, J. D. et al., 2015 [44]To examine perceptions of PC among hematologic and solid tumor oncologistsMixed method66 oncologists:
23 treating hematologic malignancies and 43 treating solid tumors - USA
Semi-structured interview and questionnaire
28Llamas, K. J., Llamas, M. et al., 2001 [45]To identify PC service needs, and educational and support
needs of hospital teaching staff
Quantitative - Cross-sectional267 multi-disciplinary oncology staff (medical, nursing, radiation therapy and other disciplines) - AustraliaQuestionnaire
29Mahon, M. M. and McAuley, W. J., 2010 [46]To examine nurses’ points of views and beliefs about PC and PC decision makingQualitative12 oncology nursing - USAInterview
30McDarby, M. and Carpenter, B. D., 2019 [64]To identify factors that impede or facilitate the palliative care consultation team’s successful collaboration with other health care professionalsQualitative48 providers (19 palliative care providers, 29 nonpalliative care providers) - USAInterview (telephone and site)
31McGrath, P., 2013 [47]To explore issues associated with the experience of survivorship for hematology patientsQualitative50 oncology patients (Multiple Myeloma, Lymphoma, Leukemia and Other) - AustraliaOpen-ended interview and focus group
32McIlfatrick, S., 2007 [48]To assess the PC needs from the perspectives of patients, informal carers and healthcare providersMixed method76 patients and lay carers receiving PC services – United KingdomSemi-structured interview and focus-group
33Melvin, C. S., 2010 [49]To examine obstacles to timely referral to PC services and to explore the impact of late referral on quality of lifeQualitative13 patients
6 family members - Australia
34Mohammed, S., Swami, N., 2018 [50]To examine bereaved caregivers’ experiences of providing care at home for patients with advanced cancer, while interacting with home care servicesQualitative61 bereaved caregivers (30 intervention, 31 control) - CanadaSemi-structured interview
35Monterosso, L., Ross-Adjie, G. M. et al., 2016 [51]To identify HPs’ perspectives, education, and support needs related to PC provisionMixed method302 multi-disciplinary health professionals - AustraliaFocus group
36Norton, S. A., Wittink, M. N., et al., 2019 [72]To explore family caregivers’ points of view of the final month of life of patients with advanced cancerQualitative92 family caregivers of patients with end-stage cancer - USASemi-structured interview
37O’Connor, M. and Lee-Steere, R., 2006 [52]To explore general practitioners’ attitudes to PC in a rural center, in particular the perceived barriers to the provision of PCQualitative10 general practitioners - AustraliaInterview
38Odejide, D. Y. Salas Coronado, et al., 2014 [53]To explore hematologic oncologists’ perspectives and decision-making processes regarding end-of-life careQualitative20 hematologic oncologists - USAFocus group
39Patel, M. I., Periyakoil, V. S., 2018 [54]To examine clinical providers’ experiences delivering cancer care for patients at the end of life and their thoughts on potential solutions to improve quality of careQualitative75 cancer care providers (35 physicians, 20 nursing staff, 12 social workers, and 8 patient navigators) - USASemi-structured interview
40Philip, J. A. M. and Komesaroff, P., 2006 [55]To explore the concept of ideal PC and the barriers to the accessQualitative45 PC professionals from community, inpatient, and hospital consultancy services - AustraliaFocus group
41Redman, S., White, K. et al., 1995 [90]To examine PC nurses’ professional need and clinical knowledgeQuantitative - Cross-sectional108 nurses - AustraliaQuestionnaire and interview
42Rhee, J. J.-O., Zwar, N. et al., 2008 [56]To establish the level of participation of urban general practitioners and to identify the barriers which they have to face in palliative care provisionQuantitative - Cross-sectional269 general practitioners - AustraliaQuestionnaire
43Rhondali, W., Burt, S. et al., 2013 [57]To explore the oncologists’ perceptions of a supportive care program, and to determine whether renaming ‘palliative care’ influenced communication regarding referralsQualitative17 oncologists - USASemi-structured interview
44Rodriguez, K. L., Barnato, A. E. et al., 2007 [58]To explore the perceptions of PC and to identify barriers to earlier use of PC in the illness trajectoryQualitative120 health care providers (on intensive care unit) - USASemi-structured interview
45Ronaldson, S. and Devery, K., 2001 [59]To investigate the transition to palliative care servicesQualitative11 inpatients and 5 nursing staff members - AustraliaSemi-structured interview
46Rugno, C. P., Rebeiro Paiva, B. S. et al., 2014 [60]To explore women’s understanding on the reasons anticancer treatment withdrawal, their thoughts about palliative care, and also prospective on the communication of bad newsQualitative22 women with advanced cancer (14 breast, 4 cervical, 1 ovarian, and 1 endometrial cancer) - BrazilSemi-structured interview
47Sanjo, M., Morita, T., 2018 [61]To explore experiences of family members of patients with cancer receiving information concerning palliative care unit consultationsQuantitative - Survey465 family member of adult patients with cancer - JapanQuestionnaire (mail paper form)
48Schenker, Y., Crowley-Matoka, M. et al., 2014 [62]To examine oncologist factors that influence referrals to outpatient specialized PCQualitative74 medical oncologists - USAInterview
49Smith, C. B., Nelson, J. E. et al., 2012 [79]To ascertain factors influencing physicians decisions for referral to PCQuantitative - Cross-sectional155 physicians (caring for cancer patients) - USASelf-administered questionnaire
50Walshe, C., Chew-Graham, C. et al., 2008 [91]To examine the influences on referral decisions made
(within community PC services)
Qualitative57 healthcare professionals interviewed;
13 case notes;
84 other non-patient documents – United Kingdom
Interview, observation and documentary analysis
51Ward, A. M., Agar, M. et al., 2009 [63]To explore attitudes of medical oncologists toward collaboration with specialist PC servicesMixed method78 medical oncologists and 37 trainees – AustraliaQuestionnaire (web-based)
52Zhang, Z. and Cheng, W.W., 2014 [65]To explore the process to access and role of PCQualitative1 patient (doctor) – ChinaObservation