Abstract
BackgroundSpecialist palliative care teams (SPCTs) in hospitals improve quality of life and satisfaction with care for patients with advanced disease. However, referrals to SPCTs are often limited. To identify areas for improvement of SPCTs’ service penetration, we explored the characteristics and level of integration of palliative care programmes and SPCTs in Dutch hospitals and we assessed the relation between these characteristics and specialist palliative care referral rates.MethodsWe performed a secondary analysis of a national cross-sectional survey conducted among hospitals in the Netherlands from March through May 2018. For this survey, a previously developed online questionnaire, containing 6 consensus-based integration indicators, was sent to palliative care programme leaders in all 78 hospitals. For referral rate we calculated the number of annual inpatient referrals to the SPCT as a percentage of the number of total annual hospital admissions. Referral rate was dichotomized into high (≥ third quartile) and low (< third quartile). Characteristics of SPCTs with high and low referral rate were compared using univariate analyses. P-values < 0.05 were considered significant.ResultsIn total, 63 hospitals (81%) participated in the survey, of which 62 had an operational SPCT. The palliative care programmes of these hospitals consisted of inpatient consultation services (94%), interdisciplinary staffing (61%), outpatient clinics (45%), dedicated acute care beds (21%) and community-based palliative care (27%). The median referral rate was 0.56% (IQR 0.23–1.0%), ranging from 0 to 3.7%. Comparing SPCTs with high referral rate (≥1%, n = 17) and low referral rate (< 1%, n = 45) showed significant differences for SPCTs’ years of existence, staffing, their level of education, participation in other departments’ team meetings, provision of education and conducting research. With regard to integration, significant differences were found for the presence of outpatient clinics and timing of referrals.ConclusionIn the Netherlands, palliative care programmes and specialist palliative care teams in hospitals vary in their level of integration and development, with more mature teams showing higher referral rates. Appropriate staffing, dedicated outpatient clinics, education and research appear means to improve service penetration and timing of referral for patients with advanced diseases.
Highlights
Provision of specialist palliative care for patients with advanced disease or frailty strongly relates to a better quality of life, less depression and anxiety and higher satisfaction with care [1,2,3,4,5,6]
Over the years they have reported a steadily increasing average referral rate [19]. They demonstrated that higher staffing levels of Specialist palliative care team (SPCT) were associated with higher referral rates, which were subsequently associated with earlier initial palliative care consultation during hospital admission [18]
Non-responding hospitals consisted of 11 general hospitals and 4 teaching hospitals, of which one was certified as European Society for Medical Oncology (ESMO)-Designated Centres (DCs) of integrated oncology and Palliative Care (PC)
Summary
Provision of specialist palliative care for patients with advanced disease or frailty strongly relates to a better quality of life, less depression and anxiety and higher satisfaction with care [1,2,3,4,5,6]. As a measure for SPCTs’ service penetration, the National Palliative Care Registry in the United States used the number of annual inpatient palliative care consultations as a percentage of the number of total annual hospital admissions to determine referral rate [18]. Over the years they have reported a steadily increasing average referral rate [19]. To identify areas for improvement of SPCTs’ service penetration, we explored the characteristics and level of integration of palliative care programmes and SPCTs in Dutch hospitals and we assessed the relation between these characteristics and specialist palliative care referral rates
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