Rebecca R. Lamprecht

BACKGROUND AND STUDY AIMS: Guidelines recommend early initiation of palliative care alongside anticancer therapy. However, ongoing treatment is often associated with delayed referral to palliative care. Factors that positively influence the initiation of palliative care have been studied in the past, but there is a gap in research regarding the individual degree of influence these factors have on the willingness to initiate palliative care. Therefore, we explored the degree of influence of 11 different factors on willingness to initiate palliative care, focusing on communicational and relational aspects. METHODS: We conducted a factorial survey among 1572 members of the Swiss public. Participants were presented with vignettes designed to explore willingness to start palliative care. A response format ranging from -5 to +5 was provided. Vignettes were analysed using mixed-effects regression models. RESULTS: The physician having enough time for the conversation, the provision of detailed and understandable information, and an expression about continuity of care led to the strongest increase in willingness. There was also an increase in willingness when treatment recommendations were based on experience and patient preferences, as well as with self-disclosure, the expression of sadness by the physician, work experience, a prior patient-physician relationship and older patient age. CONCLUSION: This study offers insight into the decision-making process regarding the initiation of palliative care at an advanced stage of disease progression. Supportive communication practices and expressions of understanding for the other led to a higher willingness to start palliative care. These aspects should be considered in discussions about advanced cancer in clinical practice, as well as emphasised in medical education.