Bonares Michael, Mah Kenneth, Christiansen David, Granton John, Weiss Andrea, Lau Christine, Rodin Gary, Zimmermann Camilla, Wentlandt Kirsten
Division of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
BMJ Support Palliat Care. 2021 Dec 3. doi: 10.1136/bmjspcare-2021-003386.
Patients 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.
Respirologists 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.
The 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).
Possible 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.
慢性呼吸道疾病患者有显著的姑息治疗需求，但对专科姑息治疗（SPC）服务的利用率较低。获得SPC服务的机会减少导致该患者群体的姑息治疗需求未得到满足。我们试图确定加拿大呼吸科医生向SPC的转诊情况。
邀请加拿大各地的呼吸科医生参与一项关于他们向SPC转诊情况的调查。使用回归分析来分析转诊情况与人口统计学、专业和态度因素之间的关联。
回复率为64.7%（438/677）。59%的受访者认为他们的患者对姑息治疗有负面看法，39%的受访者表示如果将姑息治疗重新命名为支持性护理，他们更有可能更早地转诊至SPC。虽然只有2.7%的人从未转诊至SPC，但52.6%的转诊医生转诊较晚。较低的转诊频率与将姑息治疗等同于临终护理（p<0.001）、呼吸科医生为男性（p=0.019）、不了解SPC服务的转诊标准（p=0.015）以及认同SPC服务优先考虑癌症患者（p=0.025）相关；较高的转诊频率与对SPC服务的满意度（p=0.001）相关。转诊较晚与将姑息治疗等同于临终护理（p<0.001）以及认同SPC服务优先考虑癌症患者（p=0.013）相关。
呼吸科医生及时转诊至SPC的可能障碍包括对姑息治疗的误解、对转诊标准缺乏认识以及认为SPC服务优先考虑癌症患者。未来的研究应证实这些障碍并评估克服这些障碍的策略的有效性。
