Facilitators and Barriers of Palliative Care Receipt from the Perspective of People with Advanced Liver Cancer (GP125)

Outcomes 1. Identify factors that serve as either facilitators of or barriers to palliative care referral from the perspective of patients receiving systemic treatment for hepatocellular carcinoma, the most common type of liver cancer.2. Name specific ways that future scientific inquiry might advance our understanding of these facilitators and barriers, including the development of tailored, embedded care models within liver cancer treatment programs. Key Message Interviews with people currently receiving treatments for advanced liver cancer reveal that in the absence of symptoms, they may not want or see a need for palliative care. Embedded palliative care, case finding, and stakeholder engagement are likely needed to develop effective and acceptable care models for this population. Importance Little is known of the patient-based facilitators and barriers for palliative care delivery to people with advanced hepatocellular carcinoma (HCC), the most common primary liver cancer. This is crucial information to develop and test HCC-specific palliative care interventions. Because of improvements in treatment this population is living longer and palliative needs and preferences may be changing. Objective(s) Identify facilitators and barriers to palliative care delivery for people receiving systemic treatment for advanced stage HCC. Scientific Methods Utilized Inclusion criteria included adults with advanced (Barcelona C) HCC receiving systemic treatment. Nineteen were enrolled in the study, and 11 completed semi-structured interviews about their experience. For English- and Spanish-speaking individuals interviews were conducted in English and Spanish respectively; a professional interpreter was used for others. The interview guide included questions about palliative care using the Center to Advance Palliative Care's public-facing definition. Interviews were transcribed/translated and verified, a code book was developed using open coding, and all interviews coded using axial coding. Results Median age was 64.9 years, 11% were women, 26% identified as Black, 21% identified as Asian, 21% identified as Hispanic/Latinx, and 50% of the interviews were conducted in English. Most participants felt positively toward palliative care but did not feel they needed it. Overall, facilitators identified included need for symptom management and worry about things getting worse. Barriers included lack of awareness, not wanting additional support or providers, and stigma (association with end-of-life, opioids, and being a burden on the system). Conclusion(s) Participants had a positive reaction to palliative care, however most did not feel it would benefit them at time of interview. A targeted, embedded model of palliative care may be well-suited for this population. Impact Future work in this area should involve development and testing of care models (e.g. embedded and primary palliative care models) in collaboration with patients and families.