Pulmonary referrals to specialist palliative medicine: a survey

Abstract

ObjectivesPatients with chronic respiratory disease have significant palliative care needs, but low utilisation of specialist palliative care (SPC) services. Decreased access to SPC results in unmet palliative care needs among this patient population. We sought to determine the referral practices to SPC among respirologists in Canada.MethodsRespirologists across Canada were invited to participate in a survey about their referral practices to SPC. Associations between referral practices and demographic, professional and attitudinal factors were analysed using regression analyses.ResultsThe response rate was 64.7% (438/677). Fifty-nine per cent of respondents believed that their patients have negative perceptions of palliative care and 39% were more likely to refer to SPC earlier if it was renamed supportive care. While only 2.7% never referred to SPC, referral was late in 52.6% of referring physicians. Lower frequency of referral was associated with equating palliative care to end-of-life care (p<0.001), male sex of respirologist (p=0.019), not knowing referral criteria of SPC services (p=0.015) and agreement that SPC services prioritise patients with cancer (p=0.025); higher referral frequency was associated with satisfaction with SPC services (p=0.001). Late referral was associated with equating palliative care to end-of-life care (p<0.001) and agreement that SPC services prioritise patients with cancer (p=0.013).ConclusionsPossible barriers to respirologists’ timely SPC referral include misperceptions about palliative care, lack of awareness of referral criteria and the belief that SPC services prioritise patients with cancer. Future studies should confirm these barriers and evaluate the effectiveness of strategies to overcome them.

Identifying barriers and facilitators to palliative care integration in the management of hospitalized patients with COVID-19: A qualitative study

“…34,35 In previous studies concerning other non-malignant disease states such as heart failure, COPD, and dementia, an unpredictable disease trajectory similarly acted as a barrier to palliative care integration. [20][21][22][23][24][25][26] Palliative care resource flexibility and collaboration have been outlined as facilitators to referral in COPD 24 and dementia populations 26 comparable to our findings of the facilitator 'team readiness and adaptability' of palliative services to manage patients with COVID-19.…”

“…Although several studies have outlined the planning and implementation of palliative care initiatives for current and past pandemics, 7 , 12 to our knowledge this is the first study to explore the factors influencing the integration of palliative care into the management of patients with COVID-19 and their families. Previous studies have explored barriers to integrating palliative care into care for general medical populations, 17 , 18 as well as for those with cancer, 19 advanced heart disease, 20 – 22 chronic obstructive pulmonary disease (COPD) 23 – 25 and dementia. 26 The most prevalent barriers concern education, including lack of knowledge concerning what palliative care is (and what it is not), clarity around referral processes, and lack of primary palliative care skills.…”

An update of palliative care in lung transplantation with a focus on symptoms, quality of life and functional outcomes

“…The ability of PC to support patient function has been poorly studied and is only indirectly measured in mixed scales of HRQL assessments. This is also believed to be complicated by the lateness of referrals, and progressive deterioration faced by patients with advanced lung disease [16,36 ▪▪ ,37 ▪ ,38]. Thus, the literature on PC effects in the advanced lung disease and transplant populations has been mixed [17 ▪▪ ,18,19 ▪▪ ].…”

A review of the trends in the first six years of a palliative care unit in Trinidad and Tobago

“…The relatively low numbers of non-cancer referrals may reflect a lack of awareness among referrers of the role of palliative care in non-malignant conditions. 16,17 Between 2014 and 2020, despite an increase in service uptake, there was a reduction in the proportion of non-cancer referrals to OPC and for admission. Targeted approaches may be needed to raise awareness among referring medical specialists.…”