Skip to main content Accessibility help
×
Home

Timing of referral to inpatient palliative care services for advanced cancer patients and earlier referral predictors in mainland China

  • Xiaoli Gu (a1), Wenwu Cheng (a1), Menglei Chen (a1), Minghui Liu (a1) and Zhe Zhang (a1)...

Abstract

Objective:

Routine early integration of palliative care with advanced cancer management is not yet a part of standard practice in many countries, including mainland China. Whether patients in China suffering from advanced cancer are referred to palliative care services in a timely manner remains unclear. We sought to investigate the timing of palliative care referral of Chinese cancer patients at our center and its predictors.

Method:

Retrospective medical data including demographic characteristics and referral information were collected for analysis. A total of 759 patients referred to our palliative care unit (PCU) from January of 2007 to December of 2013 were included in the final analysis.

Results:

The mean age of the 759 patients included in the study was 62.89 years (range 61.95–63.82). Some 369 patients (48.6%) were male and 559 (73.6%) Shanghainese (indigenous). Lung cancer (17.9%) was the most common diagnosis. The time interval since enrollment into the PCU until a patient's death (length of stay, LOS) was calculated. A longer LOS indicated earlier referral to inpatient PC services. The median LOS was 21 days (CI 95% = 19.79–22.21). Multivariate analysis showed that whether or not the patient was indigenous (p = 0.002) and younger than 65 (p = 0.031) were independent factors for a longer LOS. Such other characteristics as gender and primary cancer type bore no relationship to LOS.

Significance of results:

Our findings demonstrate that Chinese cancer patients are referred relatively late in the course of their disease to inpatient palliative care services. To overcome the barriers to early integration of palliative care into a patient's treatment plan, accurate information about palliative care must be provided to both oncologists and patients via comprehensive and systematic educational programs.

Copyright

Corresponding author

Address correspondence and reprint requests to: Wenwu Cheng, Department of Integrated Therapy, Fudan University, Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China, #270 Dong An Road, Shanghai, People's Republic of China. E-mail: wenwucheng@yahoo.com.

References

Hide All
Baek, Y.J., Shin, D.W., Choi, J.Y., et al. (2011). Late referral to palliative care services in Korea. Journal of Pain and Symptom Management, 41(4), 692699.
Bakitas, M., Lyons, K.D., Hegel, M.T., et al. (2009). Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The project ENABLE II randomized controlled trial. The Journal of the American Medical Association, 302(7), 741749.
Bakitas, M.A., Tosteson, T.D., Li, Z., et al. (2015). Early versus delayed initiation of concurrent palliative oncology care: Patient outcomes in the ENABLE III randomized controlled trial. Journal of Clinical Oncology, 33(13), 14381445.
Brickner, L., Scannell, K., Marquet, S., et al. (2004). Barriers to hospice care and referrals: Survey of physicians' knowledge, attitudes, and perceptions in a health maintenance organization. Journal of Palliative Medicine, 7(3), 411418.
Christakis, N.A. & Escarce, J.J. (1996). Survival of Medicare patients after enrollment in hospice programs. The New England Journal of Medicine, 335(3), 172178.
Christakis, N.A. & Iwashyna, T.J. (1998). Attitude and self-reported practice regarding prognostication in a national sample of internists. Archives of Internal Medicine, 158(21), 23892395.
Corbett, C.L., Johnstone, M., Trauer, J.M., et al. (2013). Palliative care and hematological malignancies: Increased referrals at a comprehensive cancer centre. Journal of Palliative Medicine, 16(5), 537541.
Cosgriff, J.A., Pisani, M., Bradley, E.H., et al. (2007). The association between treatment preferences and trajectories of care at the end of life. Journal of General Internal Medicine, 22(11), 15661571.
Dudgeon, D.J., Raubertas, R.F., Doerner, K., et al. (1995). When does palliative care begin: A needs assessment of cancer patients with recurrent disease. Journal of Palliative Care, 11(1), 59.
Earle, C.C., Park, E.R., Lai, B., et al. (2003). Identifying potential indicators of the quality of end-of-life cancer care from administrative data. Journal of Clinical Oncology, 21(6), 11331138.
Earle, C.C., Neville, B.A., Landrum, M.B., et al. (2005). Evaluating claims-based indicators of the intensity of end-of-life cancer care. International Journal for Quality in Health Care, 17(6), 505509.
Friedman, B.T., Harwood, M.K. & Shields, M. (2002). Barriers and enablers to hospice referrals: An expert overview. Journal of Palliative Medicine, 5(1), 7384.
Greer, J.A., Jackson, V.A., Meier, D.E., et al. (2013). Early integration of palliative care services with standard oncology care for patients with advanced cancer. CA: A Cancer Journal for Clinicians, 63(5), 349363.
Halkett, G.K.B., Jiwa, M., Meng, X.Q., et al. (2014). Referring advanced cancer patients for palliative treatment: A national structured vignette survey of Australian GPs. Family Practice, 31(1), 6070.
Hui, D., Elsayem, A., de la Cruz, M., et al. (2010). Availability and integration of palliative care at U.S. cancer centers. The Journal of the American Medical Association, 303(11), 10541061.
Hui, D., Kim, S.H., Roquemore, J., et al. (2014). Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients. Cancer, 120(11), 17431749.
Iwashyna, T.J. & Christakis, N.A. (1998). Attitude and self-reported practice regarding hospice referral in a national sample of internists. Journal of Palliative Medicine, 1(3), 241248.
Kwon, J.H., Hui, D., Chisholm, G., et al. (2013). Clinical characteristics of cancer patients referred early to supportive and palliative care. Journal of Palliative Medicine, 16(2), 148155.
Mack, J.W., Weeks, J.C., Wright, A.A., et al. (2010). End-of-life discussions, goal attainment, and distress at the end of life: Predictors and outcomes of receipt of care consistent with preferences. Journal of Clinical Oncology, 28(7), 12031208.
Meng, Q., Xu, L., Zhang, Y.G., et al. (2012). Trends in access to health services and financial protection in China between 2003 and 2011: A cross-sectional study. Lancet, 379(9818), 805814.
Osta, B.E., Palmer, J.L., Paraskevopoulos, T., et al. (2008). Interval between first palliative care consult and death in patients diagnosed with advanced cancer at a comprehensive cancer center. Journal of Palliative Medicine, 11(1), 5157.
Sanders, B.S., Burkett, T.L., Dickinson, G.E., et al. (2004). Hospice referral decisions: The role of physicians. The American Journal of Hospice & Palliative Care, 21(3), 196202.
Schenker, Y., Crowley-Matoka, M., Dohan, D., et al. (2014). Oncologist factors that influence referrals to subspecialty palliative care clinics. Journal of Oncology Practice, 10(2), 3744.
Schockett, E.R., Teno, J.M., Miller, S.C., et al. (2005). Late referral to hospice and bereaved family member perception of the quality of end-of-life care. Journal of Pain and Symptom Management, 30(5), 400407.
Smith, T.J., Temin, S., Alesi, E.R., et al. (2012). American Society of Clinical Oncology provisional clinical opinion: The integration of palliative care into standard oncology care. Journal of Clinical Oncology, 30(8), 880887.
Snyder, S., Hazelett, S., Allen, K., et al. (2013). Physician knowledge, attitude, and experience with advance care planning, palliative care, and hospice: Results of a primary care survey. The American Journal of Hospice & Palliative Care, 30(5), 419424.
Stillman, M.J. & Syrjala, K.L. (1999). Differences in physician access patterns to hospice care. Journal of Pain and Symptom Management, 17(3), 157163.
Temel, J.S., Greer, J.A., Muzikansky, A., et al. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. The New England Journal of Medicine, 363(8), 733742.
Weckmann, M.T. (2008). The role of the family physician in the referral and management of hospice patients. American Family Physician, 77(6), 807812.
Zimmermann, C., Swami, N., Krzyzanowska, M., et al. (2014). Early palliative care for patients with advanced cancer: A cluster-randomised controlled trial. Lancet, 383(9930), 17211730.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed