Oncologists face layered barriers to goals-of-care talks, review finds

Oncologists encounter a web of personal, patient-related and institutional obstacles that delay or derail goals-of-care conversations with people being treated for cancer, according to a scoping review published in BMC Palliative Care on 28 October 2026.

Goals-of-care discussions are conversations in which clinicians and patients align treatment decisions with the patient’s values, preferences and priorities. The review’s authors note that these discussions are frequently delayed or inconsistently implemented in oncology, and that while previous research has examined barriers from patient perspectives, less attention has been given to the challenges experienced by oncologists themselves.

The team, led by Nasong Anthony Luginaah, conducted the scoping review following the methodological framework of Arksey and O’Malley and Levac et al., and reported it according to PRISMA-ScR guidelines. They systematically searched five databases — PubMed, Web of Science, EMBASE, MEDLINE and Scopus — for peer-reviewed English-language studies published up to 4 October 2026 that examined barriers to goals-of-care or advance care planning discussions from the perspective of oncologists.

The search identified 763 records, of which 25 studies met the inclusion criteria. The included studies were published between 2010 and 2026, and most originated from North America, accounting for 15 of the 25. Data were extracted and synthesized using an inductive thematic analysis approach.

The analysis organized barriers into three overarching domains: personal, patient-related and institutional factors. Personal barriers included prognostic and timing uncertainty, emotional and cognitive burden, and concerns about communication difficulties and the physician–patient relationship.

At the patient level, the review identified patient or family unreadiness, cultural and demographic factors, and disagreement between patients and families regarding care goals as key obstacles. These findings suggest that even when an oncologist is prepared to initiate the conversation, the readiness of patients and their families can shape whether and when it happens.

Institutional barriers included time constraints, inadequate training, documentation challenges and limited resources. The authors conclude that these challenges extend beyond individual oncologists and reflect broader communication, workflow and system-level limitations.

As plausible targets for future intervention development, the review points to structured communication training, clearer delineation of team responsibilities, improved documentation systems, and dedicated time and resources.

The authors are careful to note the scope of what the review does and does not show. Because it did not evaluate the comparative effectiveness of interventions addressing these barriers, they call for future research to develop and evaluate such interventions to support earlier, patient-centered goals-of-care discussions in oncology practice.

As a scoping review, the study maps the existing literature rather than testing an intervention, and its findings reflect the 25 studies that met its inclusion criteria, most of them from North America. Within that scope, it offers a structured picture of why conversations about care goals often happen later or less consistently than clinicians and patients might want, and where the levers for change may lie.

Subject of Research: Barriers oncologists face when initiating and conducting goals-of-care discussions in oncology

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

Article References: Luginaah, N. A., Mohamed, I., Albert, M., Chen, K., Wagter, C., Luginaah, N., & Taabazuing, M. (2026). Barriers to goals-of-care discussions in oncology: a scoping review of oncologist perspectives. BMC Palliative Care. https://doi.org/10.1186/s12904-026-02400-w

Image Credits: AI Generated

DOI: 10.1186/s12904-026-02400-w

Keywords: goals-of-care discussions, oncology, scoping review, advance care planning, palliative care, communication barriers, oncologists, institutional barriers, prognostic uncertainty, BMC Palliative Care, Barriers, goals-of-care