{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T20:23:41Z","timestamp":1787862221201,"version":"build-2784847793"},"reference-count":50,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"8","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Glob Oncol"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>Timely discussion of goals of care (GoC) between oncologists and patients with advanced cancer can improve end-of-life (EoL) decision making, ensuring that care aligns with individual preferences. However, barriers at multiple levels could limit timely EoL communication. This cross-sectional study examined oncologists' perceptions of barriers to GoC discussions regarding EoL processes among patients in Puerto Rico.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A 26-item questionnaire was distributed to oncologists in Puerto Rico, assessing three barrier domains (patient and family; physician; and systemic or external factors) and oncologists' willingness to engage in GoC discussions. Data were collected between April 2024 and January 2025. Descriptive statistics were used to summarize oncologists' characteristics. Differences in oncologists\u2019 characteristics and willingness to engage in the decision-making process were assessed with the Mann-Whitney test (non-normally distributed data). Associations between barriers and oncologists' characteristics, such as age and training, were explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 60 oncologists across Puerto Rico (approximately 50% participation rate) completed the questionnaire. Over 65% identified patient- and family-related factors as the primary barriers to EoL discussions. Although 58.3% of oncologists had not received formal training in EoL, they did not perceive this as a significant barrier. Yet, those without formal training faced greater barriers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Family and patient factors emerged as the predominant barriers. Despite oncologists' willingness to engage in EoL discussions, the absence of formal training may hinder these conversations. Further research should focus on communication training and initiatives to provide oncologists, patients, and families with valuable resources for EoL decision making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/go-26-00060","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T19:59:12Z","timestamp":1787860752000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Perceived Barriers Faced by Puerto Rican Oncologists During Goals-of-Care Discussions With Patients With Advanced Cancer"],"prefix":"10.1200","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4091-4104","authenticated-orcid":true,"given":"Marjorie","family":"V\u00e1zquez-Rold\u00e1n","sequence":"first","affiliation":[{"name":"Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1844-0130","authenticated-orcid":true,"given":"Rosa","family":"Rom\u00e1n-Oyola","sequence":"additional","affiliation":[{"name":"Occupational Therapy Program, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Ramos-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5363-7299","authenticated-orcid":true,"given":"Axel","family":"Gierbolini-Berm\u00fadez","sequence":"additional","affiliation":[{"name":"Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3596-4304","authenticated-orcid":true,"given":"Tonatiuh","family":"Su\u00e1rez-Ramos","sequence":"additional","affiliation":[{"name":"Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3614-7034","authenticated-orcid":true,"given":"Carlos R.","family":"Torres-Cintr\u00f3n","sequence":"additional","affiliation":[{"name":"Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yannira","family":"Campos-Mercado","sequence":"additional","affiliation":[{"name":"Division of Research and Educational Support, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico"},{"name":"Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5501-3034","authenticated-orcid":true,"given":"Kalyani","family":"Sonawane","sequence":"additional","affiliation":[{"name":"Hollings Cancer Center, Medical University of South Carolina, Charleston, SC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0134-9947","authenticated-orcid":true,"given":"Karen J.","family":"Ortiz-Ortiz","sequence":"additional","affiliation":[{"name":"Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico"},{"name":"Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2024.5436"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.13193"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-019-5333-x"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-015-2885-4"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.7205\/MILMED-D-15-00005"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.300.14.1665"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2024.101706"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2016.10.001"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24761"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.7732"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2024.3172"},{"key":"e_1_3_8_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049909119848148"},{"key":"e_1_3_8_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.15997"},{"key":"e_1_3_8_15_2","doi-asserted-by":"publisher","DOI":"10.1200\/EDBK_431352"},{"key":"e_1_3_8_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/jjco\/hyr092"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP.20.00039"},{"key":"e_1_3_8_18_2","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2014-0031"},{"key":"e_1_3_8_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/jjco\/hyaa146"},{"key":"e_1_3_8_20_2","doi-asserted-by":"publisher","DOI":"10.3390\/epidemiologia5040050"},{"key":"e_1_3_8_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-025-14271-0"},{"key":"e_1_3_8_22_2","first-page":"13","article-title":"A shrinking primary care workforce in Puerto Rico","volume":"101","author":"Wilkinson E","year":"2020","unstructured":"Wilkinson E, Killeen D, Perez-Lopez GJ, et al: A shrinking primary care workforce in Puerto Rico. Am Fam Physician 101:13-14, 2020","journal-title":"Am Fam Physician"},{"key":"e_1_3_8_23_2","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2018.00102"},{"key":"e_1_3_8_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000002115"},{"key":"e_1_3_8_25_2","doi-asserted-by":"publisher","DOI":"10.1200\/OP.20.00541"},{"key":"e_1_3_8_26_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1533-2500.2010.00421.x"},{"key":"e_1_3_8_27_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.4014"},{"key":"e_1_3_8_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049909112448926"},{"key":"e_1_3_8_29_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19158967"},{"key":"e_1_3_8_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.outlook.2012.08.008"},{"key":"e_1_3_8_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049909113480841"},{"key":"e_1_3_8_32_2","first-page":"4","article-title":"A framework for improving the quality of cancer care: The case of breast and cervical cancer screening","volume":"12","author":"Zapka JG","year":"2003","unstructured":"Zapka JG, Taplin SH, Solberg LI, et al: A framework for improving the quality of cancer care: The case of breast and cervical cancer screening. Cancer Epidemiol Biomarkers Prev 12:4-13, 2003","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"e_1_3_8_33_2","doi-asserted-by":"publisher","DOI":"10.1093\/jncimonographs\/lgs008"},{"key":"e_1_3_8_34_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djh284"},{"key":"e_1_3_8_35_2","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2012.000800"},{"key":"e_1_3_8_36_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-018-0288-2"},{"key":"e_1_3_8_37_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951509000303"},{"key":"e_1_3_8_38_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.75.2311"},{"key":"e_1_3_8_39_2","first-page":"160","volume-title":"Ley de Declaraci\u00f3n Previa de Voluntad Sobre Tratamiento M\u00e9dico (17 de noviembre de 2001, seg\u00fan enmendada)","author":"Estado Libre Asociado de Puerto Rico","year":"2001","unstructured":"Estado Libre Asociado de Puerto Rico. Ley de Declaraci\u00f3n Previa de Voluntad Sobre Tratamiento M\u00e9dico (17 de noviembre de 2001, seg\u00fan enmendada). San Juan, Puerto Rico: Oficina de Gerencia y Presupuesto 160-2001, 2001"},{"key":"e_1_3_8_40_2","volume-title":"Ley N\u00fam. 218-2024: Para enmendar la Ley N\u00fam. 160 de 2001, Ley de Declaraci\u00f3n Previa de Voluntad sobre Tratamiento M\u00e9dico (23 de septiembre de 2024)","author":"Estado Libre Asociado de Puerto Rico","year":"2024","unstructured":"Estado Libre Asociado de Puerto Rico. Ley N\u00fam. 218-2024: Para enmendar la Ley N\u00fam. 160 de 2001, Ley de Declaraci\u00f3n Previa de Voluntad sobre Tratamiento M\u00e9dico (23 de septiembre de 2024). San Juan, Puerto Rico: Oficina de Gerencia y Presupuesto, 2024"},{"key":"e_1_3_8_41_2","doi-asserted-by":"publisher","DOI":"10.1111\/hex.12549"},{"key":"e_1_3_8_42_2","doi-asserted-by":"publisher","DOI":"10.11144\/Javeriana.upsy16-2.sdsw"},{"key":"e_1_3_8_43_2","first-page":"296","article-title":"Facilitators and barriers for initiating conversations about end of life","volume":"3","author":"Smith MA","year":"2022","unstructured":"Smith MA, Br\u00f8chner AC, Nedergaard HK, et al: Facilitators and barriers for initiating conversations about end of life. Palliat Med Rep 3:296-307, 2022","journal-title":"Palliat Med Rep"},{"key":"e_1_3_8_44_2","doi-asserted-by":"publisher","DOI":"10.1177\/2050640614558345"},{"key":"e_1_3_8_45_2","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11152222"},{"key":"e_1_3_8_46_2","first-page":"e13737","article-title":"It needs experience and courage': Awareness towards end of life communication practices in oncologists: A mixed methods study","volume":"31","author":"Diendorfer T","year":"2022","unstructured":"Diendorfer T, Roider-Schur S, L\u00fctgendorf-Caucig C, et al: It needs experience and courage': Awareness towards end of life communication practices in oncologists: A mixed methods study. Eur J Cancer Care 31:e13737, 2022","journal-title":"Eur J Cancer Care"},{"key":"e_1_3_8_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apjon.2022.100167"},{"key":"e_1_3_8_48_2","doi-asserted-by":"publisher","DOI":"10.1200\/EDBK_100038"},{"key":"e_1_3_8_49_2","first-page":"e13546","article-title":"Will I or my loved one die? Concordant awareness between terminal cancer patients and their caregivers is associated with lower patient anxiety and caregiver burden","volume":"31","author":"Lai C","year":"2022","unstructured":"Lai C, Aceto P, Pellicano GR, et al: Will I or my loved one die? Concordant awareness between terminal cancer patients and their caregivers is associated with lower patient anxiety and caregiver burden. Eur J Cancer Care 31:e13546, 2022","journal-title":"Eur J Cancer Care"},{"key":"e_1_3_8_50_2","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2012.28"},{"key":"e_1_3_8_51_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4733.2005.04054.x"}],"container-title":["JCO Global Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/GO-26-00060","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T19:59:18Z","timestamp":1787860758000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/GO-26-00060"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":50,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1200\/GO-26-00060"],"URL":"https:\/\/doi.org\/10.1200\/go-26-00060","relation":{},"ISSN":["2687-8941"],"issn-type":[{"value":"2687-8941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-01-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-05","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e2600060"}}