| BARRIERS | COMMENT |
| Poor estimation and prognostication |
|
| Difficulty delivering difficult news | Fear of harm Fear of disappointing |
| Fear of patient or family anger |
|
| Clinical trials push | Pressure to enroll patients on trials Financial incentives Academic incentives |
| Lack of training in palliative care |
|
| Fragmentation of healthcare | Lack of multidisciplinary cancer care team Lack of resources – rural environment |
| Institutional culture | Legal resources in the setting of medical futility Ethics committee support |