Barriers to goals-of-care discussions in oncology: a scoping review of oncologist perspectives

Goals-of-care (GoC) conversations are essential in oncology to ensure treatment decisions align with patient values, preferences, and priorities. Despite their importance, these discussions are frequently delayed or inconsistently implemented. While previous research has explored barriers from patient perspectives, less focus has been given to the challenges experienced by oncologists themselves. This scoping review aimed to map the existing literature on barriers that oncologists face when initiating and conducting GoC discussions. A scoping review was conducted following the methodological framework of Arksey and O’Malley and Levac et al. and reported according to PRISMA-ScR guidelines. Five databases (PubMed, Web of Science, EMBASE, MEDLINE, and Scopus) were systematically searched for peer-reviewed English-language studies published up to October 4, 2026. Studies examining barriers to GoC or advance care planning discussions from the perspective of oncologists were included. Data was extracted and synthesized using an inductive thematic analysis approach. The search identified 763 records, with 25 studies meeting inclusion criteria. Included studies were published between 2010 and 2026, with most originating from North America ( n = 15). Barriers were categorized into three overarching domains: personal, patient-related, and institutional factors. Personal barriers included prognostic and timing uncertainty, emotional and cognitive burden, concerns regarding communication difficulties and physician–patient relationships. Patient-level barriers included patient or family unreadiness, cultural and demographic factors, and disagreement between patients and families regarding care goals. Institutional barriers included time constraints, inadequate training, documentation challenges, and limited resources. Oncologists encounter multifactorial barriers that limit timely and effective GoC discussions. These challenges extend beyond individual oncologists and reflect broader communication, workflow, and system-level limitations. Structured communication training, clearer delineation of team responsibilities, improved documentation systems, and dedicated time and resources represent plausible targets for future intervention development. Given that this review did not evaluate the comparative effectiveness of interventions addressing these barriers, future research should develop and evaluate such interventions to support earlier, patient-centered GoC discussions in oncology practice.