Artikel: Use and timing of referral to specialized palliative care services for people with cancer: A mortality follow-back study among treating physicians in Belgium
Referral to specialized palliative care services (SPCS) occurs often late in the illness trajectory
but may differ across cancer types. We examined differences between cancer types in
the use and timing of referral to specialized palliative care services (SPCS) and in the reasons
for non-referral.
Methods
We conducted a population-based mortality follow-back survey among physicians who certified
a representative sample of deaths in Flanders, Belgium. We focused only on sampled
death cases of cancer (n = 2392). The questionnaire asked about the use of the existing
types of SPCS and the timing of referral to these services.
Results
Response rate was 58% (1394/2392). Patients who died from breast, respiratory, head and
neck, genitourinary or gastrointestinal cancer had higher chances of using SPCS compared
to hematologic cancer patients. The most prevalent reason for non-referral was that regular
care sufficiently addressed palliative and supportive care needs (51%). This differed significantly
between cancer types ranging from 77,8% for breast cancer and 42.1% for hematologic
cancer. A second prevalent reason for not using SPCS was that it was not meaningful
(enough) (23.9%), particularly for hematologic malignancies (35,1%) and only in 5.3% for
breast cancer.
Conclusion
Differences in referral across different types of cancer were found. Referral is more often
delayed or not initiated for patients with hematologic cancer, possibly due to differences in
illness trajectory. An influencing reason is that physicians perceive palliative care as not
meaningful or not meaningful enough for these patients which may be linked to the uncertainty
in the disease trajectory of hematologic malignancies