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Pulmonary referrals to specialist palliative medicine: a survey
  1. Michael Bonares1,2,
  2. Kenneth Mah3,
  3. David Christiansen4,5,
  4. John Granton2,6,
  5. Andrea Weiss3,7,
  6. Christine Lau1,7,
  7. Gary Rodin3,8,
  8. Camilla Zimmermann2,3 and
  9. Kirsten Wentlandt3,7
  1. 1Division of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  2. 2Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
  4. 4Section of Respiratory Medicine, St Boniface General Hospital, Winnipeg, Manitoba, Canada
  5. 5Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  6. 6Division of Respirology, University Health Network, Toronto, Ontario, Canada
  7. 7Department of Community and Family Medicine, University of Toronto, Toronto, Ontario, Canada
  8. 8Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Kirsten Wentlandt, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Kirsten.Wentlandt{at}uhn.ca

Abstract

Objectives 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.

Methods 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.

Results 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).

Conclusions 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.

  • chronic obstructive pulmonary disease
  • respiratory conditions
  • chronic conditions
  • clinical decisions
  • transitional care

Data availability statement

Data are available upon reasonable request. Data may be requested by contacting MB (michael.bonares@mail.utoronto.ca).

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Data availability statement

Data are available upon reasonable request. Data may be requested by contacting MB (michael.bonares@mail.utoronto.ca).

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Footnotes

  • Twitter @gary_rodin

  • Contributors Study design was primarily contributed to by KW, DC, JG and CZ; data acquisition was primarily contributed to by KW, AW and CL; data analysis and interpretation was primarily contributed to by MB, KM and KW; drafting the article was primarily contributed to by MB, KM and KW; revision of the article was primarily contributed to by DC, JG, AW, CL, GR and CZ. All authors approved the final version of the manuscript and take public responsibility for its content. KW is responsible for the overall content as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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