Referral Practices of Oncologists to Specialized Palliative Care

1. Kirsten Wentlandt, Monika K. Krzyzanowska, Nadia Swami, Gary M. Rodin, Lisa W. Le and Camilla Zimmermann⇓

© 2012 by American Society of Clinical Oncology+ Author Affiliations

1. Kirsten Wentlandt, Monika K. Krzyzanowska, Gary M. Rodin, and Camilla Zimmermann, University of Toronto; Kirsten Wentlandt, Monika K. Krzyzanowska, Nadia Swami, Gary M. Rodin, Lisa W. Le, and Camilla Zimmermann, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.

1. Corresponding author: Camilla Zimmermann, MD, PhD, Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, 610 University Ave, 16-712, Toronto, Ontario, Canada, M5G 2M9; e-mail: camilla.zimmermann@uhn.on.ca.

1. Presented in part at the Canadian Association for Psychosocial Oncology Conference, May 4-6, 2011, Toronto, Ontario, Canada.

Abstract

Purpose To describe current referral practices of oncologists to specialized palliative care (SPC) and define demographic characteristics, practice situations, and opinions associated with referral.

Methods Physician members of the Canadian Association of Medical Oncologists, Canadian Association of Radiation Oncologists, and Canadian Society of Surgical Oncology were invited to participate in an anonymous survey assessing SPC referral practices. Participants received two e-mailed and two mailed invitations. 

Results The response rate was

 72% (603 of 839 physicians); 

37% were medical oncologists/hematologists, 

50% were radiation oncologists, and 

12% were surgical oncologists. 

Ninety-four percent reported that SPC was available to them, but only 37% reported that these services accepted patients on chemotherapy. 

Eighty-four percent referred terminally ill patients usually/always, but generally for uncontrolled symptoms or discharge planning late in the disease course.

 One third would refer to SPC earlier if it was renamed supportive care. 

Predictors of higher referral frequency included comprehensiveness of available SPC services (P = .004), satisfaction with SPC availability (P < .001), SPC acceptance of patients receiving chemotherapy (P < .001), and oncologist ease with referring patients to a palliative care service before they were close to death (P < .001).

 Controlling for specialty, predictors of referral at diagnosis or during chemotherapy, rather than later, included satisfaction with SPC service availability (P < .001) and SPC service acceptance of patients on chemotherapy (P < .001).

Conclusion 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.

Footnotes

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• Supported by the Canadian Cancer Society (Grant No. 020509; C.Z.) and the Ontario Ministry of Health and Long-Term Care. C.Z. is supported by the Rose Family Chair in Supportive Care, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
• The funding agency had no role in the design or conduct of the study; the collection, analysis, or interpretation of the data; or the preparation, review, or approval of the article.
• Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

• Received May 4, 2012.
• Accepted September 11, 2012.