title: Predictors of referral for specialized psychosocial oncology care in patients with metastatic cancer: the contributions of age, distress, and marital status.
abstract: OBJECTIVE
  This study examines the rate and prediction of referral for specialized psychosocial oncology care in 326 patients with metastatic GI or lung cancer.
  
  
  METHODS
  Referral information was abstracted from medical records and hospital databases. Patients completed measures of psychosocial and physical distress and functioning.
  
  
  RESULTS
  Routine referral occurred in 33% of patients, and in 42% and 44%, respectively, of those scoring high on measures of depression (Beck Depression Inventory [BDI]-II >or= 15) and hopelessness (Beck Hopelessness Scale >or= 8). Univariate analyses indicated that referral was associated with younger age, unmarried status, living alone, presence of more depressive symptoms, hopelessness, and attachment anxiety, and with less social support, self-esteem, and spiritual well-being (all P < .05). Among the significantly depressed (BDI-II >or= 15), 100% of those less than 40 years of age, but only 22% of those age 70 years or older were referred. Multivariate analyses indicated that referral was associated with younger age, unmarried status, and presence of more depressive symptoms. Moreover, increasing age was associated with a progressively lower likelihood of referral independent of the level of distress.
  
  
  CONCLUSIONS
  Routine referral of patients with metastatic cancer for psychosocial oncology care was predicted by presence of more severe depressive symptoms, younger age, and unmarried status. The rate of referral progressively declined with each decade of age, even among those with significant distress. These findings are consistent with some aspects of Andersen's model of health care utilization. The extent to which referred patients represent those who are most likely to benefit deserves further investigation.
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada. gary.rodin@uhn.on.ca
authors.forename: Janet
authors.initials: J
authors.lastname: Ellis
authors.forename: Judy
authors.initials: J
authors.lastname: Lin
authors.forename: Andrew
authors.initials: A
authors.lastname: Walsh
authors.forename: Christopher
authors.initials: C
authors.lastname: Lo
authors.forename: Frances A
authors.initials: FA
authors.lastname: Shepherd
authors.forename: Malcolm
authors.initials: M
authors.lastname: Moore
authors.forename: Madeline
authors.initials: M
authors.lastname: Li
authors.forename: Lucia
authors.initials: L
authors.lastname: Gagliese
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
authors.forename: Gary
authors.initials: G
authors.lastname: Rodin
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000150:complications; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008175:Lung Neoplasms / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012017:Referral and Consultation; D012944:Social Support