Barriers to access to palliative care services perceived by gastric cancer patients, their caregivers and physicians in Santander, Colombia

Abstract

Gastric cancer (GC) is a public health issue with high incidence and mortality in Colombia due to tardy diagnosis and barriers to access to curative treatment; this leaves palliative care (PC) as the only option. Our aim is to describe the access barriers to PC perceived by adults with GC, caregivers and physician in Santander, Colombia. A qualitative study was carried out with the analysis of the grounded theory (Strauss and Corbin), through semi-structured interviews, after sampling for convenience we found that the access barriers were: administrative, economic, cultural, knowledge, communication, institutional and geographical; strategies to overcome barriers: screening programs, governmental surveillance, and investment in health. In conclusion, access to PC requires remove barriers to timely and integral access and strengthen health and education policies to facilitate procedures and services that ensure the attention required by the adult with GC.

A Systematic Review on Barriers to Palliative Care in Oncology

“…The 29 studies identified included 8 quantitative studies, [25][26][27][28][29][30][31][32] 18 qualitative studies, [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] and 3 mixed-methods studies. [52][53][54] The sample size ranged from 10 participants to 313 participants.…”

“…Seven studies examined the barriers to PC utilization related to persons with cancer and their family. 29,30,35,40,42,49,50 The most common patient-related barriers included negative images/ stereotyping of PC, denial of the terminal nature of the disease/unrealistic expectations, and economic/logistic barriers. These are discussed below.…”

“…Negative image/stereotype of PC. Some studies found patients and families possessed negative stereotypes about PC and lacked knowledge and awareness about PC, 29,30,42 lacked knowledge about their disease trajectory, 49 and felt stigmatized by their communities following the cancer diagnosis. 35 They believed that PC required forgoing cancer therapy and equated PC with EOL care.…”

“…35 They believed that PC required forgoing cancer therapy and equated PC with EOL care. 49 In addition, patients and families reported that physicians described PC as pain management services 35 and did not discuss or refer them to PC. 29,30 Finally, they reported experiencing communication barriers with physicians which hindered their understanding of the disease.…”

Palliative Care and Oncology in Colombia: The Potential of Integrated Care Delivery

“…As of 2014, Colombia has organised legislation regarding the availability of palliative care with the aim of guaranteeing access to palliative care to all patients who may benefit from such care, including those with cancer and non-cancer diseases [ 21 ]. Nevertheless, the offer of palliative care services in the country is still scarce and mainly limited to hospital-based settings and centralised in large cities [ 22 , 23 , 24 , 25 ], despite the fact that throughout the country, there was an increase in palliative care services from 23 in 2013 to 79 in 2020. This increase in service provision is still insufficient for the needs of the population [ 26 ], whereas the global atlas of palliative care outlined Colombia [ 27 ] as having generalised palliative care provision [ 28 ].…”