Predictors of referral to specialised palliative care at a University Hospital: Towards purposeful commitment of a limited resource

Abstract

Purpose Palliative Care (PC) can be divided into general PC (GPC) as an integrated part of patient care in all fields of medicine and specialised PC (SPC), which is usually provided within palliative care units (PCUs) by specialised PC physicians. To date, the criteria on which patients are selected for SPC or GPC are not standardized. Such information would be vital for increasing the efficiency of the limited resource of SPC. The present study aims at identifying criteria associated with the referral to SPC in a large University hospital. Methods This retrospective single-centre study evaluated the total of 704 PC consultation requests between March 2016 and August 2020 to examine characteristics of patients who were referred to SPC at a PCU compared to those receiving GPC. To analyse criteria correlated with referral to PCU, binary logistic regression was conducted. Significant variables were then incorporated into a multivariate logistic regression model. Results The total of 704 PC consultation requests included 374 requests for a referral to SPC and 330 requests for a PC consultation, only. Of the 374 patients for whom the treating physician requested a referral to SPC, 145 (38.8%) patients were actually referred. Statistically significant factors associated with referral to SPC were the need for pain management (OR = 2.3) and nutritional advice (OR = 4.4). Conclusion Indicated triggers requiring SPC included complex symptom burdens, particularly pain and nutrition problems. Further education regarding these findings could help to ameliorate targeted use of the limited resource SPC.