Communication Barriers and Facilitators to Specialist Pediatric Palliative Care Involvement in Pediatric Oncology Settings Across Canada

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OBJECTIVES: To examine how healthcare provider communication shapes referral, acceptance and ongoing integration of specialist pediatric palliative care (SPPC). METHODS: A qualitative study was conducted across four pediatric cancer centers in Canada. Sixty-six healthcare providers working in oncology and palliative care settings participated in in-depth interviews. Participants included physicians, nurses, psycho-social clinicians and other members of the interprofessional health team. Transcripts were analyzed using iterative, inductive coding based on the Grounded Theory method. RESULTS: Communication barriers to referral and acceptance included inadequate explanations for SPPC involvement, incomplete or misleading descriptions of services, and framing SPPC solely as end-of-life care. Oncologist discomfort, avoidance, and use of ambiguous "coded" language further hindered referral conversations. Facilitators included strong communication skills, clear and comprehensive explanations of SPPC, and age-appropriate engagement with patients. For ongoing integration of SPPC, poor interprofessional communication and unclear role and responsibilities among team members created risks for fragmented care. In contrast, structured collaboration such as joint meetings, shared care planning, and proactive information exchange, supported effective integration of SPPC and consistent messaging to patients and families. CONCLUSIONS: Communication is central to successful SPPC referral, acceptance, and integration in pediatric oncology settings. Both clinician-family and interprofessional communication practices directly shaped understanding and engagement with SPPC services. Interventions should prioritize communication training, clearer framing of SPPC, and enhanced collaboration between teams. Early involvement of the psychosocial provider along with an SPPC specialist may further improve communication and uptake, ultimately strengthening care for children with serious illness and their families.

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