Abstract

Few studies have investigated appropriate referral timing of specialized palliative care (SPC) from the perspective of cancer patients' and families' experiences. We aimed to clarify appropriate SPC referral timing for patients with advanced cancer and their families. We used data from a nationwide bereaved family survey in Japan. We sent a questionnaire to 999 bereaved families of cancer patients who died in 164 palliative care units (PCUs) and analyzed the first SPC referral timing and how patients evaluated it. We defined SPC as outpatient or inpatient palliative care service comprising certified palliative care physicians, advanced-practice nurses, and multidisciplinary practitioners. Finally, 51.6% (n = 515) of all responses were analyzed. The SPC referral timing was evaluated as appropriate (26.1%), late or too late (20.2%), early or too early (1.2%), or none of these (52.5%). Of these, 32.3% reported that they were referred to an SPC when diagnosed with advanced or incurable cancer or during anti-cancer treatment, and 62.6% reported they were referred after anti-cancer treatment. Patient-perceived appropriateness of SPC referral timing was associated with their good death process. After excluding "none of these" responses, a significantly higher proportion of respondents who reported being referred to SPC at diagnosis and during anti-cancer treatment evaluated the response timing as appropriate, compared to those who reported being referred after anti-cancer treatment. Appropriate timing for SPC referrals relates to quality of death; findings suggest that appropriate timing is at the time of diagnosis or during anti-cancer treatment.

Highlights

  • Clinicians need to know appropriate timing for specialized palliative care service (SPC) referral based on patient and family reported outcomes derived from their experiences through cancer diagnosis, anti-cancer treatment, and end of life care; few studies have investigated the appropriate SPC referral timing

  • We developed a hypothesis that there may be a relationship between patient-perceived appropriateness of SPC referral timing and their quality of death

  • We evaluated quality of death using the short form of the Good Death Inventory (GDI) [21, 22]

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Summary

Introduction

Clinicians need to know appropriate timing for specialized palliative care service (SPC) referral based on patient and family reported outcomes derived from their experiences through cancer diagnosis, anti-cancer treatment, and end of life care; few studies have investigated the appropriate SPC referral timing. There is growing evidence supporting a need to integrate palliative care and oncological care, especially early access to SPC for patients with advanced cancer [7,8,9,10,11,12]. Those have demonstrated that early SPC involvement is associated with quality of life, symptom burden, depression, mood, patient and caregiver satisfaction, and possibly survival, and that it positively impacts end of life quality care indicators [7,8,9,10,11,12].

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