Specialist Palliative Care Referral Practices Among Oncologists, Cardiologists, Respirologists: A Comparison of National Survey Studies

Michael Bonares; Lisa W Le; Camilla Zimmermann; Kristen Wentlandt

doi:10.1016/j.jpainsymman.2023.01.014

Specialist Palliative Care Referral Practices Among Oncologists, Cardiologists, Respirologists: A Comparison of National Survey Studies

J Pain Symptom Manage. 2023 Jul;66(1):e1-e34. doi: 10.1016/j.jpainsymman.2023.01.014. Epub 2023 Feb 14.

Authors

Michael Bonares¹, Lisa W Le², Camilla Zimmermann³, Kristen Wentlandt⁴

Affiliations

¹ 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. Electronic address: michael.bonares@mail.utoronto.ca.
² Department of Biostatistics (L.W.L.), Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
³ Division of Palliative Medicine (M.B., C.Z.), Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Supportive Care (C.Z., K.W.), University Health Network, Toronto, Ontario, Canada.
⁴ Department of Supportive Care (C.Z., K.W.), University Health Network, Toronto, Ontario, Canada; Division of Palliative Care (K.W.), Department of Community and Family Medicine, University of Toronto, Toronto, Ontario, Canada.

PMID: 36796528
DOI: 10.1016/j.jpainsymman.2023.01.014

Abstract

Context: 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.

Objectives: We compared referral practices to SPC among cardiologists, respirologists, and oncologists, discerned from surveys (the Canadian Palliative Cardiology/Respirology/Oncology Surveys).

Methods: 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).

Results: 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).

Conclusion: 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.

Keywords: Palliative care; cancer; chronic obstructive pulmonary disease; health care disparity; heart failure; referral.

MeSH terms

Attitude of Health Personnel
Canada
Cardiologists*
Humans
Neoplasms* / therapy
Oncologists*
Palliative Care
Practice Patterns, Physicians'
Referral and Consultation