Background: Integrated specialist palliative care (PC) is known to improve outcomes among ambulatory patients with cancer, yet it remains underutilized for this population. It is known that PC is poorly understood among the public, however very little is known about what ambulatory patients with cancer understand about PC or what barriers to access exist. Methods: Outpatients undergoing cancer treatment completed a survey evaluating their familiarity and knowledge of PC (Palliative Care Knowledge Scale; PaCKS), feelings towards PC (before and after reading a standardized definition of PC), barriers to PC, prognostic awareness, and health literacy. We examined variables associated with participants’ familiarity with PC and current interest in receiving PC by fitting logistic regression models. To determine if there was a difference in patients’ feelings toward PC before and after reading the standardized definition, a Chi-Squared test was conducted. All other responses were summarized descriptively. Results: Of 151 participants, 58.9% reported familiarity with palliative care. The average PaCKs score was 11.9 (standard deviation 1.4), and 46.4% of patients received a perfect score, indicating high knowledge of PC overall. Only time since diagnosis (> 1 year vs < 1 year) was associated with significantly increased odds of being familiar with PC (OR 2.93; 95% CI 1.37-6.25). After reading the standardized definition of PC, participants reported feeling significantly less anxious and more reassured; however, more participants were interested in receiving PC in the future compared to at the time of survey completion (74.2% vs 44.4%, respectively). Patients with stage III or IV cancer had significantly increased odds of having interest in receiving PC at the time of study completion compared to patients with stage I or II (OR 2.66; 95% CI: 1.05, 6.76). Having an aggressive cancer was not associated with interest in receiving PC at the time of study completion. Logistic barriers (additional travel or time at the hospital) were commonly reported barriers to attending palliative care appointments. Conclusions: Outpatients with cancer who are being treated at a large academic cancer center have higher familiarity and knowledge of PC than the average American adult. Despite this, anxiety surrounding PC and hesitations regarding early integration of PC persist. Therefore, factors outside of knowledge may be perpetuating the delayed or lack of involvement with PC in oncology. Future work must seek to overcome these barriers to PC integration in outpatient cancer care.