'They Need to Hear You Say It': Healthcare Professionals' Perspectives on Barriers and Enablers to End-of-Life Discussions With Adolescents and Young Adults With Cancer.

End-of-life conversations with adolescents and young adults (AYAs) with cancer rarely occur without the guidance of healthcare professionals. As a part of the 'Difficult Discussions' study, focused on palliative care and advance care planning discussions with AYAs with cancer, we investigated the factors that healthcare professionals identify as barriers and facilitators to end-of-life conversations. Twenty-eight multidisciplinary healthcare professionals participated in semi-structured interviews exploring conversations focused on end-of-life care (29% oncologists/haematologists, 39% nurses and 32% allied health professionals). Data were analysed through qualitative content analysis using an inductive approach. The conversations were shaped by factors at the healthcare professionals' personal, interpersonal, teams and hospital system levels, as well as being influenced by cultural and societal influences. Barriers at each level included patients' and caregivers' emotional needs; patients' maturity levels; lack of relational trust between patient, caregiver and healthcare professional; and the social taboo of speaking about death with young people. Conversely, good communication between members of the multidisciplinary team was identified as a facilitator, as working effectively in a team was found to mitigate some of the emotional burden and logistical constraints of conducting end-of-life conversations. The results of this study offer new insights into how the interplay of these factors acts as facilitators and barriers to communication. Further research could explore the communication processes that facilitate trust between the AYA and healthcare team, factors associated with AYAs' readiness and the optimal time to conduct end-of-life conversations.