Centre for Health Research and Psycho-oncology, Cancer Council NSW, University of Newcastle, Hunter Medical Research Institute and Priority Research Centre for Health Behaviour, New South Wales, Australia.
J Palliat Med. 2011 Apr;14(4):429-35. doi: 10.1089/jpm.2010.0259. Epub 2011 Mar 8.
Doctors in Australia play an important role in facilitating access to specialist palliative care (SPC) services for people with advanced cancer. This study aimed to describe doctors' perceptions of barriers to referring patients for SPC, and to identify triggers and facilitators for referral.
Forty semistructured telephone interviews were conducted with doctors involved in the care of people with advanced cancer from a variety of settings.
Six themes were identified: disease and treatment; psychosocial; communication and interpersonal issues; health services issues; timing; and, health professionals' skills. All doctors considered the presence and complexity of physical symptoms, stage of the disease and treatment orientation as important in decisions to refer for SPC. Less important were the psychosocial well-being and cultural characteristics of the person with cancer and their family. Factors reportedly affecting referral and access included health professionals' ability to communicate openly and honestly about disease progression, availability and location of SPC resources and doctors' expertise. Divergent views were expressed about appropriate timing for access. The predominant view that SPC is for management of physical symptoms may result in nonreferral of those who have complex problems without physical symptoms.
Given the complex relationship between psychological and physical well-being and health-related quality of life, it is important that all factors contributing to patient well-being are identified. Routine use of objective measures of unmet and complex needs may help identify people who are likely to most benefit from SPC and optimize access, regardless of timing, stage of disease, and treatment orientation.
在为晚期癌症患者提供专科姑息治疗（SPC）服务方面，澳大利亚的医生发挥着重要作用。本研究旨在描述医生对患者转诊至 SPC 的障碍的看法，并确定转诊的触发因素和促进因素。
对来自不同环境的参与晚期癌症患者护理的医生进行了 40 次半结构化电话访谈。
确定了六个主题：疾病和治疗；心理社会；沟通和人际问题；卫生服务问题；时间；以及，卫生专业人员的技能。所有医生都认为，身体症状的存在和复杂性、疾病阶段和治疗方向在决定转诊至 SPC 时很重要。癌症患者及其家属的心理社会幸福感和文化特征则不太重要。据报道，影响转诊和获得的因素包括卫生专业人员是否能够公开、诚实地沟通疾病进展情况，SPC 资源的可用性和位置以及医生的专业知识。对于适当的就诊时间，表达了不同的看法。SPC 主要用于管理身体症状的观点可能导致那些没有身体症状但存在复杂问题的人未被转诊。
鉴于心理和身体幸福感以及与健康相关的生活质量之间存在复杂的关系，重要的是确定所有有助于患者福祉的因素。常规使用未满足和复杂需求的客观衡量标准，可能有助于确定最有可能从 SPC 中受益的人群，并优化就诊机会，无论时间、疾病阶段和治疗方向如何。
