Referral Practices of Oncologists to Specialized Palliative Care

Abstract

Oncologists referred patients frequently to SPC, but generally late in the disease course for patients with uncontrolled symptoms. Availability of comprehensive SPC, especially for patients receiving chemotherapy, and persisting definitional issues seem to be the main barriers preventing timely referral.

Symptom burden and supportive care in patients with acute leukemia

“…However, there have been no prospective studies assessing referral to palliative care and psychosocial services for patients with acute leukemia and correlating these data with symptom severity. Palliative care referral tends to occur late in the course of disease for patients with cancer [16], particularly for those with hematological malignancies [17][18][19]. Retrospective studies have found that for patients with hematological malignancies palliative care referral tends to occur within approximately 2 weeks of patient death, compared to approximately two months in patients with solid tumors, despite similar symptom severity [18,19].…”

Perceptions of palliative care among patients with advanced cancer and their caregivers

“…[3][4][5] Nevertheless, referrals to palliative care are typically made late in the disease course. 6,7 Negative attitudes toward palliative care among patients and caregivers are often cited by physicians as a reason for late referrals to palliative care services, 6,8 and a change of name to "supportive care" has been proposed. 8,9 Although some studies have reported on attitudes of oncologists and other physicians toward palliative care and its name, 6,8,[10][11][12] there has been scant research on the perspectives of patients and caregivers.…”

“…6,7 Negative attitudes toward palliative care among patients and caregivers are often cited by physicians as a reason for late referrals to palliative care services, 6,8 and a change of name to "supportive care" has been proposed. 8,9 Although some studies have reported on attitudes of oncologists and other physicians toward palliative care and its name, 6,8,[10][11][12] there has been scant research on the perspectives of patients and caregivers. Previous surveys of patients and/or caregivers have solicited opinions about either the quality of palliative care received 13,14 or about the acceptability of the name "palliative care" versus "supportive care" for those who might be referred.…”

A Pilot Study on Undergraduate Palliative Care Education – A Study on Changes in Knowledge, Attitudes and Self-Perception

“…In medical practice, unconscious ambivalent or negative emotions (e.g. fear of dying and death) are associated with various avoidance strategies and, ultimately, with a lower quality of medical practice [3,[14][15][16][17][18]. Presumably, the reverse is also true, that a positive change of attitude improves the quality of care [19].…”