title: Analysis of referral initiatives, severity of illness and return to care of older women with cervical cancer.
abstract: BACKGROUND
  Cervical cancer is a worldwide malignancy particularly prevalent in older women. Due to the increasing population ratio of older women and their more complicated illnesses, doctors in Taiwan are concerned about the care of older patients with cervical cancer. Few studies have been performed on the association between referral initiative and illness severity upon referral as well as the tendency of older patients with cervical cancer to return to the referring doctor and to the consultant at the medical center for follow-up. The purpose of this study was to investigate the referral association by adjusting for confounding variables.
  
  
  METHODS
  This study included 214 women aged 65 years and over with cervical cancer diagnosed between 1987 and 1995. Patients were referred to a tertiary teaching hospital by 71 primary care gynecologists. The International Federation of Gynecology and Obstetrics clinical stage and clinical severity were assessed in each patient. Histopathologic results were reviewed to confirm the diagnosis.
  
  
  RESULTS
  Of all the cervical cancer referrals, 20.2% were initiated by patients or families and 79.8% were initiated by primary care doctors. No statistically significant differences were found in the Basic Activities of Daily Living or Instrumental Activities of Daily Living between doctor- and patient-initiated referrals. High Geriatric Depression Scale and low Mini-Mental State Examination were associated with doctor-initiated referrals. Higher cancer stage and greater clinical severity of patients with cervical cancer was found in patient- rather than doctor-initiated referrals. After adjusting for marriage, family type, medical payment, mental status, cancer stage and clinical severity, the data showed that, if the referral was initiated by a primary care doctor, older patients with cervical cancer had a similar likelihood to return to both the primary care doctor and the tertiary teaching hospital for follow-up.
  
  
  CONCLUSIONS
  If a referral was initiated by a doctor, older women with cervical cancer were not only likely to return to their consulting physician at the medical center, but also likely to return to their primary care doctor. Continuous care is more likely to occur when the primary care doctor initiated the referral.
authors.affiliation: Graduate Research Institute of Medicine, Kaohsiung Medical College, Taiwan, ROC.
authors.forename: W C
authors.initials: WC
authors.lastname: Hsu
authors.forename: J N
authors.initials: JN
authors.lastname: Lee
authors.forename: P L
authors.initials: PL
authors.lastname: Tsai
authors.forename: H J
authors.initials: HJ
authors.lastname: Lin
authors.forename: C M
authors.initials: CM
authors.lastname: Su
authors.forename: I
authors.initials: I
authors.lastname: Lee
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D012017:Referral and Consultation; D002583:Uterine Cervical Neoplasms / Q000628:therapy*