Abstract C062: Barriers to end-of-life discussions with advanced cancer patients: Experiences of Puerto Rican oncologists

Background: Patients with cancer at the end of life (EoL) often receive high-intensity care with low therapeutic value, diminishing the quality of life and posing a public health concern. Timely communication between the patient and oncologist about treatment goals can reduce emotional distress, ensure medical care consistent with individual preferences, and lower costs by avoiding non-beneficial interventions. Documented barriers to timely EoL communications include the desire to seek treatment and keep hope, lack of training, and difficulties in estimating survival time. In Puerto Rico (PR), no studies have explored oncologists' barriers when engaging in EoL discussions. Objective: Examine oncologists' perceptions of barriers to discussions to inform decisions regarding EoL processes among patients in PR. Methods: A cross-sectional study was conducted using a questionnaire developed by You et al. (2015). This questionnaire was translated from English into Spanish and validated using an expert panel and cognitive interviews. The instrument consisted of 26 items assessing four domains: 1) barriers related to patient and family, 2) barriers related to their role as oncology providers, 3) barriers related to systemic or external factors, and 4) oncologists’ willingness to engage in the EoL decision-making process. A 5-point Likert scale was used for the first three domains, ranging from 'did not limit me' to 'limited me too much'. Oncologists’ willingness was evaluated using a 4-point Likert scale ranging from ‘not willing’ to ‘completely willing’. Data were collected from April 2024 to January 2025. Descriptive statistics were used to summarize oncologists' characteristics and barriers in EoL communication. The chi-square test assessed associations between perceived barriers and physician characteristics. Results: A total of 60 oncologists across PR (32 female, 28 male; ∼50% participation rate) completed the questionnaire. More than 65% of the oncologists perceived barriers related to family and patients as the principal barrier to EoL discussions (considering responses from ‘limited me a bit’ to ‘limited me too much’). A total of 71.7% of oncologists perceived family members' difficulty accepting the patient’s prognosis as the most limiting barrier, followed by the patient’s incapacity to make decisions (66.7%) and family members’ inability to understand the effect of life-extending treatment (65.0%). While 58.3% of oncologists did not receive formal training on EoL, they did not perceive a lack of training as a significant barrier. However, those without formal training faced more barriers that limited them. Meanwhile, 95.0% of participants showed willingness to initiate, engage, and participate in EoL discussions. Conclusions: Family and patient factors emerged as the main barriers. Although oncologists are willing to discuss EoL (95.0%), a lack of formal training can hinder these conversations. Further research is needed on training programs that equip oncologists, patients, and families with valuable tools for EoL decision-making. Citation Format: Marjorie Vazquez-Roldan, Karen Ortiz-Ortiz, Rosa Roman-Oyola, Johanna Maysonet-Cruz, Yisel Pagán-Santana, Carlos Torres-Cintron, Tonatiuh Suarez-Ramos, Yannira Campos-Mercado, Lizzie Ramos-Tollinchi, Axel Gierbolini-Bermudez, Maria Ramos-Fernandez. Barriers to end-of-life discussions with advanced cancer patients: Experiences of Puerto Rican oncologists [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C062.