Survey of specialist palliative care services for noncancer patients in Ireland and perceived barriers.
BACKGROUND
Specialist palliative care (SPC) services in Ireland are well developed by international standards. However, standardized information on all patients of SPC services is not collected so the proportion of patients seen with a noncancer diagnosis is just an estimate at 5%.


OBJECTIVE
To describe Irish SPC services' provision for, and attitudes to noncancer patients.


METHODS
Postal questionnaire of clinical managers of all SPC services listed in the directory of SPC services in Ireland, September 2005.


RESULTS
Sixty-five questionnaires were returned representing a 100% response rate. Twenty four percent (n = 15) of services limited availability for noncancer patients in some way. Of those services available for noncancer patients, the type of care provided to them was the same as for cancer patients in 81% of services (n = 50). The percentage of all patients seen in 2004 who had a noncancer diagnosis was 7.21%. Only 68% (n = 42) of services had a written referral policy. The top three perceived barriers by SPC service providers were the unpredictable noncancer disease trajectory (mean intensity = 6.77), the resultant difficulties with developing referral criteria (mean intensity = 6.38) and the lack of noncancer disease specific expertise (mean intensity = 5.96).


CONCLUSIONS
There is a mismatch between availability of palliative care services for noncancer patients and uptake. The noncancer disease trajectory continues to be considered a barrier to care. Imaginative models of care need to be developed that are not prognosis based.
O'Leary
Norma
N
Blackrock Hospice, Blackrock, Dublin, Ireland. normaoleary@hotmail.com
Tiernan
Eoin
E
D001291:Attitude of Health Personnel; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D010166:Palliative Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000706:statistics & numerical data*; D019452:Terminally Ill