Abstract

The referral of individuals with hepatocellular carcinoma (HCC) to palliative care remains a complex and underexplored area. This study aims to identify the factors that either promote or hinder palliative care referral as reported by clinicians treating patients with HCC. Through the development of a comprehensive code book, all interviews were coded using axial coding, with selective coding employed to pinpoint facilitators and barriers of palliative care referral. The identified facilitators included the invaluable support during transitions, assistance in managing specific symptoms, provision of psychosocial support, and positive past experiences with palliative care referrals. On the other hand, barriers encompassed concerns about feasibility, limited knowledge about palliative care and suitable candidates, absence of symptoms necessitating external referral, and fears that palliative care might be perceived as a sign of hopelessness. Participants recognized the benefits of palliative care at certain stages of the disease trajectory while also identifying barriers related to feasibility, perceived lack of need, limited awareness, and concerns about hopelessness. These findings provide actionable insights for future research to enhance the advantages of palliative care and address obstacles for individuals with HCC effectively.