Researchers: Moriah Ellen¹, Pesach Shvartzman¹, Refael Catane², Wilmosh Mermershtain³

Background: Aggressive care at end-of-life can harm quality of life without significantly improving survival. Despite best practice guidelines, oncologists continue to provide too much treatment to patients, especially at the end-of-life. Understanding the perceptions of oncologists regarding unnecessary care towards end-of-life can inform interventions and mitigate overuse.

Objectives: To understand the perceptions and experiences of oncologists regarding why overuse of services is occurring for cancer patients at the end-of-life and elucidate factors which impede the implementation of best practices at the end-of-life in cancer

Method: In-depth, semi-structured interviews were conducted with oncologists in Israel. The interview guide was based on the Theoretical Domains Framework to identify beliefs about practices in caring for patients at the end-of-life and transitioning to palliative care. Interviews were audio-recorded, transcribed, coded, and thematically analyzed.

Findings: Participants identified six major barriers and twelve major facilitators to reducing overuse at end-of-life. Barriers included patients seeking second opinions, patient and family fragility, pressure and demands from patients and families, a culture of valuing extending life, time constructs, and physicians’ emotional regulation. Physicians reduce overuse by relying on experience, communication and relationship building skills, taking ownership over their roles, confidence in their abilities, belief and recognition of the importance of appropriate care, involving families and other healthcare professionals and easing into the process. Oncologist opinions vary based on role and geographical area of practice.

Conclusions: Physicians can influence the rate of overuse as they guide patients at end-of-life. Future research should incorporate views and perspectives of other stakeholders.

Recommendations: : Findings can be utilized to help the health system in Israel reduce the overuse of unnecessary services at the end-of-life for cancer. Interventions such as palliative care referrals, multidisciplinary teams, and educational initiatives can help minimize overuse and improve quality of life for patients in their final days.

Research end date: 10/2021