Physicians and palliative care referrals

1. Physicians and palliative care referrals Amber Soulvie Research Methods Spring 2009

2. Current research… • Exploratory study on end-of-life issues: Barriers to palliative care and advance directives (Feeg & Elebiary, 2005) • Top 2 barriers were found to be 1) physician reluctance to make a referral and 2) physician lack of familiarity with availability and suitability. • Both are physician related barriers • You need not make the journey alone: Overcoming impediments to providing palliative care in a public urban teaching hospital (Ryan et al., 2002) • A primary physician impediment was defined in this study as “a failure to write orders that reflect SMPCP recommendations”. • 77% of the population had a primary physician impede on the implementation of palliative care recommendations on the initial consult. • 25% of the sample population experienced a physician not following recommendations during readmissions • Found that symptoms commonly addressed by palliative care services were often not identified by the referring physician as a reason for the consult. • Identifying Factors Affecting Utilization of an Inpatient Palliative Care Service: A Physician Survey (Snow et al., 2009) • Physicians responded yes of no to a list of barriers to referring to palliative care. Results for yes responses were as follows • “Patient or family's unrealistic expectations”: 70% • “Unfamiliarity with palliative care consult team”: 32% • “Physician loss of status as a primary provider”: 14% • Doctors’ understanding of palliative care (Hanratty et al., 2006) • Respondents seemed to understand the idea of palliative care but had less understanding of why one needed a specialist to deliver that care. • Understanding varied between different types of physicians

3. Conclusions drawn… • Physicians are often noted as barriers to the utilization of hospital based palliative care services for appropriate patients. • Many findings within the studies insinuate that there is a lack of understanding of the role of palliative care and/or the need for palliative care. • Studies that have a higher percentage of physicians as part of the sample are less likely to have physicians as the largest barrier. • There are conflicting findings among studies with physicians as the study population in regards to whether or not they understand what palliative care is and when to utilize it.

4. Related research… • A matter of definition-key elements identified in a discourse analysis of definitions of palliative care (Pastrana et al., 2008) • Identified aspects of palliative care that differ from the general medicine modality. • Identified discrepancies in the definition and interpretation of palliative care within the field.

5. Conclusion drawn… • Misconceptions and/or lack of understanding could be created by differences in the palliative medicine and general medicine modalities. This could lead to physicians not knowing when or for whom to make a referral.

6. Gaps in research… • There are discrepancies in the little research of physicians in regards to their understanding of palliative care services as well as their willingness to utilize them when appropriate.

7. Research question… • In an effort to further explore the research that physicians are a barrier to the utilization of palliative care services, this study will explore what guides physicians’ decision making when making a palliative care referral?

8. Challenges thus far… • Finding studies relevant to the topic • There are many studies on the importance of palliative care and ways to make them more effective but not many on the barriers. • Studies that were found were contradictory.

9. My research design… • Quantitative study • National survey of physicians that covers the following topics: • Understanding of palliative care • When they utilize services (for what symptoms, at what point in the progression of illness, etc.) • When do they not utilize services (their own barriers, patient and family barriers, institutional barriers)