Factors associated with referral offer and acceptance following supportive care problem identification in a comprehensive cancer service.

Abstract

To improve understanding of the triage process following distress and problem identification and the factors associated with offer and acceptance of supportive care referrals. Review of patient records/charts at a metropolitan hospital in Melbourne, Australia. Data were collected on problem identifications from 1/1/13 to 30/6/14, including patient demographics, disease and treatment information, responses to the NCCN Distress Thermometer (DT) and Problem Checklist (PC), whether referrals to supportive care services were offered and accepted/declined. Logistic regressions examined factors associated with referral offer and acceptance. Of patients completing the DT/PC, 50.1% reported a high level of distress. Overall, 61% of patients were offered referral(s), with the majority (71%) being accepted. Referrals were more likely to be offered to patients with a greater number of problems (Odds Ratio[OR]=1.18, 95%CI=1.12-1.25) and higher distress (OR=1.68, 95%CI=1.07-2.64). Referrals were more likely to be accepted by patients with a greater number of problems (OR=1.12, 95%CI=1.06-1.19) and lower distress (OR=0.58, 95%CI=0.34-1.00). The type of problem experienced by the patient was strongly related to the type of referral they were offered. At a large metropolitan hospital with in-house supportive care services, simple problem identification with the DT/PC enabled triage to services that reflected patients' needs. The findings suggest that clear referral pathways and an organisational emphasis on supportive care may facilitate service use.