Division of Palliative Medicine (M.B.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of Palliative Medicine (M.B., C.Z.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Biostatistics (L.W.L.), Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
J Pain Symptom Manage. 2023 Jul;66(1):e1-e34. doi: 10.1016/j.jpainsymman.2023.01.014. Epub 2023 Feb 14.
Although patients with nonmalignant diseases have palliative care needs similar to those of cancer patients, they are less likely to receive specialist palliative care (SPC). Referral practices of oncologists, cardiologists, and respirologists could provide insight into reasons for this difference.
We compared referral practices to SPC among cardiologists, respirologists, and oncologists, discerned from surveys (the Canadian Palliative Cardiology/Respirology/Oncology Surveys).
Descriptive comparison of survey studies; multivariable linear regression analysis of association between specialty and referral frequency. Surveys for each specialty were disseminated to physicians across Canada in 2010 (oncologists) and 2018 (cardiologists, respirologists).
The combined response rate of the surveys was 60.9% (1568/2574): 603 oncologists, 534 cardiologists, and 431 respirologists. Perceived availability of SPC services was higher for cancer than for noncancer patients. Oncologists were more likely to make a referral to SPC for a symptomatic patient with a prognosis of <one year. Cardiologists and respirologists were more likely to make a referral to services at a prognosis of <one month; and to refer earlier if palliative care was renamed supportive care. Cardiologists and respirologists had a lower frequency of referrals than oncologists, adjusting for demographic and professional characteristics (P < 0.0001 in both groups).
For cardiologists and respirologists in 2018, perceived availability of SPC services was poorer, timing of referral later, and frequency of referral lower than among oncologists in 2010. Further research is needed to identify reasons for differences in referral practices and to develop interventions to overcome them.
虽然患有非恶性疾病的患者有与癌症患者相似的姑息治疗需求，但他们不太可能接受专业的姑息治疗（SPC）。肿瘤学家、心脏病学家和呼吸科医生的转诊实践可以为这种差异提供一些原因。
我们通过（加拿大姑息心脏病学/呼吸病学/肿瘤学调查）调查比较了心脏病学家、呼吸科医生和肿瘤学家对 SPC 的转诊实践。
对调查研究进行描述性比较；使用多变量线性回归分析专业与转诊频率之间的关系。每个专业的调查都在 2010 年（肿瘤学家）和 2018 年（心脏病学家、呼吸科医生）向加拿大各地的医生发放。
调查的综合回复率为 60.9%（1568/2574）：603 名肿瘤学家、534 名心脏病学家和 431 名呼吸科医生。与非癌症患者相比，癌症患者对 SPC 服务的可获得性感知更高。对于预后<一年的有症状患者，肿瘤学家更有可能转介到 SPC。心脏病学家和呼吸科医生更有可能在预后<一个月时转介到服务；如果姑息治疗更名为支持性护理，他们会更早转介。调整人口统计学和专业特征后，与肿瘤学家相比，心脏病学家和呼吸科医生的转诊频率较低（两组均 P < 0.0001）。
对于 2018 年的心脏病学家和呼吸科医生来说，SPC 服务的可获得性感知较差，转诊时间较晚，转诊频率低于 2010 年的肿瘤学家。需要进一步研究以确定转诊实践差异的原因，并制定干预措施加以克服。
