BACKGROUND Despite the high potential to improve the quality of life of patients and families, palliative care services face significant obstacles to their use. In countries with high-resource health systems, the nonfinancial and nonstructural obstacles to palliative care services are particularly prominent. These are the cognitive barriers -knowledge and communication barriers- to the use of palliative care. To date no systematic review has given the deserved attention to the cognitive barriers and facilitators to palliative care services utilization. This study aims to synthesize knowledge on cognitive barriers and facilitators to palliative care use in oncology and hemato-oncology from the experiences of health professionals, patients, and their families. METHODS A systematic review was conducted. PubMed, PsycINFO, International Association for Hospice and Palliative Care/Cumulative Index of Nursing and Allied Health Literature (IAHPC/CINAHL), and Communication & Mass Media Complete (CMMC) were systematically searched for the main core concepts: palliative care, barriers, facilitators, perspectives, points of view, and related terms and synonyms. After screening of titles, abstracts, and full-texts, 52 studies were included in the qualitative thematic analysis. RESULTS Four themes were identified: awareness of palliative care, collaboration and communication in palliative care-related settings, attitudes and beliefs towards palliative care, and emotions involved in disease pathways. The results showed that cognitive barriers and facilitators are involved in the educational, social, emotional, and cultural dimensions of palliative care provision and utilization. In particular, these barriers and facilitators exist both at the healthcare professional level (e.g. a barrier is lack of understanding of palliative care applicability, and a facilitator is strategic visibility of the palliative care team in patient floors and hospital-wide events) and at the patient and families level (e.g. a barrier is having misconceptions about palliative care, and a facilitator is patients' openness to their own needs). CONCLUSIONS To optimize palliative care services utilization, awareness of palliative care, and healthcare professionals' communication and emotion management skills should be enhanced. Additionally, a cultural shift, concerning attitudes and beliefs towards palliative care, should be encouraged.

中文翻译：

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姑息治疗在肿瘤学和血液肿瘤学中的应用：从医疗保健专业人员、成年患者及其家人的角度对认知障碍和促进因素进行系统回顾。


背景尽管姑息治疗服务在改善患者和家庭的生活质量方面具有很大潜力，但其使用仍面临重大障碍。在卫生系统资源丰富的国家，姑息治疗服务面临的非财务和非结构性障碍尤为突出。这些是使用姑息治疗的认知障碍——知识和沟通障碍。迄今为止，还没有系统评价对姑息治疗服务利用的认知障碍和促进因素给予应有的关注。本研究旨在根据卫生专业人员、患者及其家人的经验，综合关于肿瘤学和血液肿瘤学中姑息治疗使用的认知障碍和促进因素的知识。方法进行了系统评价。系统地检索了 PubMed、PsycINFO、国际临终关怀和姑息治疗协会/护理和联合健康文献累积索引 (IAHPC/CINAHL) 以及 Communication & Mass Media Complete (CMMC)，以查找主要核心概念：姑息治疗、障碍、促进因素、观点、观点以及相关术语和同义词。经过标题、摘要和全文的筛选后，52 项研究被纳入定性主题分析。结果确定了四个主题：对姑息治疗的认识、姑息治疗相关环境中的协作和沟通、对姑息治疗的态度和信念以及疾病途径中涉及的情绪。结果表明，认知障碍和促进因素涉及姑息治疗的提供和利用的教育、社会、情感和文化层面。特别是，这些障碍和促进因素都存在于医疗保健专业层面（例如 一个障碍是缺乏对姑息治疗适用性的理解，而一个促进者是姑息治疗团队在患者楼层和全院范围的活动中以及在患者和家庭层面的战略可见性（例如，障碍是对姑息治疗有误解，以及促进者是患者对自己需求的开放态度）。结论 为了优化姑息治疗服务的利用，应提高姑息治疗的意识以及医疗保健专业人员的沟通和情绪管理技能。此外，应鼓励有关姑息治疗的态度和信念的文化转变。