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Use and timing of referral to specialized palliative care services for people with cancer: A mortality follow-back study among treating physicians in Belgium

BACKGROUND: 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...

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Autores principales: Vanbutsele, Gaëlle, Deliens, Luc, Cocquyt, Veronique, Cohen, Joachim, Pardon, Koen, Chambaere, Kenneth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336236/
https://www.ncbi.nlm.nih.gov/pubmed/30653508
http://dx.doi.org/10.1371/journal.pone.0210056
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author Vanbutsele, Gaëlle
Deliens, Luc
Cocquyt, Veronique
Cohen, Joachim
Pardon, Koen
Chambaere, Kenneth
author_facet Vanbutsele, Gaëlle
Deliens, Luc
Cocquyt, Veronique
Cohen, Joachim
Pardon, Koen
Chambaere, Kenneth
author_sort Vanbutsele, Gaëlle
collection PubMed
description BACKGROUND: 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.
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spelling pubmed-63362362019-01-31 Use and timing of referral to specialized palliative care services for people with cancer: A mortality follow-back study among treating physicians in Belgium Vanbutsele, Gaëlle Deliens, Luc Cocquyt, Veronique Cohen, Joachim Pardon, Koen Chambaere, Kenneth PLoS One Research Article BACKGROUND: 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. Public Library of Science 2019-01-17 /pmc/articles/PMC6336236/ /pubmed/30653508 http://dx.doi.org/10.1371/journal.pone.0210056 Text en © 2019 Vanbutsele et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Vanbutsele, Gaëlle
Deliens, Luc
Cocquyt, Veronique
Cohen, Joachim
Pardon, Koen
Chambaere, Kenneth
Use and timing of referral to specialized palliative care services for people with cancer: A mortality follow-back study among treating physicians in Belgium
title Use and timing of referral to specialized palliative care services for people with cancer: A mortality follow-back study among treating physicians in Belgium
title_full Use and timing of referral to specialized palliative care services for people with cancer: A mortality follow-back study among treating physicians in Belgium
title_fullStr Use and timing of referral to specialized palliative care services for people with cancer: A mortality follow-back study among treating physicians in Belgium
title_full_unstemmed Use and timing of referral to specialized palliative care services for people with cancer: A mortality follow-back study among treating physicians in Belgium
title_short Use and timing of referral to specialized palliative care services for people with cancer: A mortality follow-back study among treating physicians in Belgium
title_sort use and timing of referral to specialized palliative care services for people with cancer: a mortality follow-back study among treating physicians in belgium
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336236/
https://www.ncbi.nlm.nih.gov/pubmed/30653508
http://dx.doi.org/10.1371/journal.pone.0210056
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