Background: To promote access to quality, evidence-based palliative care (PC) and help cancer patients experience the best quality of life possible throughout the illness trajectory, the National Comprehensive Cancer Network (NCCN) has developed PC guidelines to guide symptom screening, assessment, PC interventions, and reassessment by the oncology team. We sought to evaluate use of the guidelines among NCCN member institutions. Methods: In April and May 2014 an invitation and reminders to participate in an online survey were sent electronically to NCCN PC guidelines panel members. If a panel member did not reply, individuals involved in the provision of PC at the same institution were approached. Results: Responses were received from 21 (84%) of the 25 member institutions. All of the institutions report having an interdisciplinary team with PC expertise. Among respondents, 38% have an accredited/certified PC program and 52% have an institutional PC quality improvement program in place. Fifty-two percent submit data to the National Palliative Care Registry. Forty-three percent have guidelines or triggers in place for the use of PC services. Only 10% actively employ the NCCN guidelines to screen for PC needs or make PC referrals; the guidelines are more often used to guide patient assessment (38%) and clinical practice (43%). When asked to endorse other PC referral criteria, 76% indicated the discretion of the oncology provider(s) and 29% the National Consensus Project for Quality Palliative Care. Sixty-two percent agree providers concur on the elements of PC and 29% agree as to who should receive PC. Only 19% agree early integration of PC should occur for all oncology patients and 43% agree PC referrals occur in a timely and efficient manner. The most frequently cited barriers to the provision of quality PC are: attitudes toward PC (71%), insufficient staffing (61%) and limited financial resources (57%). Conclusions: Implementation of the guidelines at NCCN member institutions is incomplete. There appears to be a lack of consensus about when and for whom PC should be provided. Future research should be designed to enhance understanding of the barriers to care and improve implementation of the guidelines.