Abstract
BackgroundSpecialist palliative care (SPC) providers tend to use the term ‘complex’ to refer to the needs of patients who require SPC. However, little is known about complex needs on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on referral to a hospice service.MethodsMulti-site sequential explanatory mixed method study consisting of a case-note review and focus groups with healthcare professionals in four UK hospices.ResultsDocumentation relating to 239 new patient referrals to hospice was reviewed; and focus groups involving 22 healthcare professionals conducted. Most patients had two or more needs documented on referral (96%); and needs were recorded across two or more domains for 62%. Physical needs were recorded for 91% of patients; psychological needs were recorded for 59%. Spiritual needs were rarely documented. Referral forms were considered limited for capturing complex needs. Referrals were perceived to be influenced by the experience and confidence of the referrer and the local resource available to meet palliative care needs directly.ConclusionsComplexity was hard to detail or to objectively define on referral documentation alone. It appeared to be a term used to describe patients whom primary or secondary care providers felt needed SPC knowledge or support to meet their needs. Hospices need to provide greater clarity regarding who should be referred, when and for what purpose. Education and training in palliative care for primary care nurses and doctors and hospital clinicians could reduce the need for referral and help ensure that hospices are available to those most in need of SPC input.
Highlights
Specialist palliative care (SPC) providers tend to use the term ‘complex’ to refer to the needs of patients who require SPC
People with advanced illness should be referred to specialist palliative care (SPC) services if they have needs that cannot be addressed by usual care
Specialist palliative care services are those offered by multidisciplinary National Health Service (NHS) teams or hospices employing staff with the requisite qualifications and expertise to support terminally ill people and their families
Summary
Specialist palliative care (SPC) providers tend to use the term ‘complex’ to refer to the needs of patients who require SPC. People with advanced illness should be referred to specialist palliative care (SPC) services if they have needs that cannot be addressed by usual care. Criteria for specialist palliative care referral include a diagnosis of advanced cancer, physical symptoms, low performance status, psychosocial distress, advance care planning needs, family concerns and patient request [1]. Hospices offer a wide range of services, freeof-charge, to address the physical, psychological, social and spiritual needs of people with a terminal illness and their families. These can be inpatient, community-based or can involve attending the hospice as an outpatient or day patient. As hospice services have developed to suit the needs of their local population and receive only partial statutory funding through local commissioning processes, there is much variability in the services offered [7,8,9]
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