Palliative and Supportive Care

Original Articles

Palliative care referral practices and perceptions: The divide between metropolitan and non-metropolitan general practitioners

Claire E. Johnsona1, Afaf Girgisa1 c1, Christine L. Paula1 and David C. Currowa2

a1 Centre for Health Research and Psycho-oncology, The Cancer Council NSW/University of Newcastle and Hunter Medical Research Institute, Newcastle, Australia

a2 Department of Palliative and Supportive Services, Flinders University, Adelaide, Australia

Abstract

Objective: Late or non-referral of patients to specialist palliative care (SPC) services may affect patients' and their carers' quality of care. General practitioners (GPs) are key professionals in linking people with SPC. The aim of this article is to assess GPs' perceptions and SPC referrals for their patients with advanced cancer and differences between metropolitan (M GPs) and non-metropolitan GPs (NM GPs).

Method: Self-report survey mailed to a stratified random sample of 1,680 Australian GPs was used.

Results: Thirty-one percent (469) of eligible GPs returned surveys. More M GPs than NM GPs reported referring >60% of their patients for SPC (p = 0.014); and that a more comprehensive range of SPC services was available. The most frequently reported referral prompts were: presence of terminal illness (M GPs, 71%, NM GPs, 66%, ns (not significant)); future need for symptom control (69% vs. 59%, ns) and uncontrolled physical symptoms (63% vs. 54%, ns). Reasons for not referring were: doctor's ability to manage symptoms (62% vs. 68%, ns) and the absence of symptoms (29% vs. 18%, p = 0.025). Higher referral was associated with: having a palliative care physician or consultative service available; agreeing that all patients with advanced cancer should be referred, and agreeing that with SPC, the needs of the family are better met.

Significance of results: Referrals for SPC were primarily disease-related rather than for psychological and emotional concerns. Measures are needed to encourage referrals based upon psychosocial needs as well as for physical concerns, and to support GPs caring for people with advanced cancer in areas with fewer comprehensive SPC services.

(Received November 01 2008)

(Accepted November 16 2008)

Correspondence:

c1 Address correspondence and reprint requests to: Afaf Girgis, Centre for Health Research and Psycho-oncology, The Cancer Council NSW/University of Newcastle and Hunter Medical Research Institute, Locked bag 10, Wallsend NSW 2287, Australia. Email: Afaf.girgis@newcastle.edu.au