Johnson C E, Girgis A, Paul C L, Currow D C
Centre for Health Research and Psycho-oncology (CHeRP), The Cancer Council NSW, University of Newcastle and Hunter Medical Research Institute, Newcastle.
Palliat Med. 2008 Jan;22(1):51-7. doi: 10.1177/0269216307085181.
Cancer specialists can facilitate timely and appropriate access to specialized palliative care (SPC) services. To better match patients' needs with access to SPC services, we must understand factors associated with referral. This study aimed to investigate cancer specialists' referral practices, perceptions of, barriers to and triggers for referral of people with advanced cancer to SPC services.
A self-report questionnaire was mailed to all oncologists, clinical haematologists, respiratory physicians and colorectal surgeons in Australia (N = 1713).
Out of 699 specialists who participated, 48% reported referring >60% of patients to SPC services. Most frequent reasons for referral were: the future need for symptom control, the presence of a terminal illness or uncontrolled physical symptoms. Psychosocial issues rarely triggered referral. Main reasons reported for not referring included: ability to manage patients' symptoms; the absence of symptoms or rapid deterioration. Significant predictors of referral (P < 0.05) included: being female; >10 years of practice in the speciality; agreeing all people with advanced cancer need referral, referral for the purpose of multidisciplinary management and having SPC services available.
Specialists mainly refer people with advanced cancer for symptom-related reasons. Measures are needed to encourage ongoing needs-based assessments, especially of emotional, cultural and spiritual issues.
癌症专科医生可促进及时且恰当地获得专科姑息治疗（SPC）服务。为使患者需求与SPC服务的可及性更好匹配，我们必须了解与转诊相关的因素。本研究旨在调查癌症专科医生对晚期癌症患者转诊至SPC服务的转诊做法、看法、障碍及触发因素。
向澳大利亚所有肿瘤学家、临床血液学家、呼吸内科医生和结直肠外科医生邮寄了一份自填式问卷（N = 1713）。
在参与的699名专科医生中，48%报告将60%以上的患者转诊至SPC服务。最常见的转诊原因是：未来对症状控制的需求、存在终末期疾病或身体症状未得到控制。心理社会问题很少引发转诊。报告的未转诊主要原因包括：有能力管理患者症状；无症状或病情迅速恶化。转诊的显著预测因素（P < 0.05）包括：女性；该专科领域执业超过10年；认同所有晚期癌症患者都需要转诊、为多学科管理目的进行转诊以及有SPC服务可用。
专科医生主要因与症状相关的原因转诊晚期癌症患者。需要采取措施鼓励持续进行基于需求的评估，尤其是对情感、文化和精神问题的评估。
