title: Late referral to palliative care services in Korea.
abstract: BACKGROUND
  Although timely referral to palliative care services can help improve quality of life by minimizing patient and family suffering during a life-threatening illness, it remains unclear whether patients in Korea who suffer from advanced cancer are referred to palliative care services in a timely manner.
  
  
  OBJECTIVE
  We aimed to investigate the timeliness of patient referral to palliative care services in Korea by examining the duration of survival after enrollment and identify the factors contributing to earlier or later referral.
  
  
  METHODS
  Patient- and episode-level data were collected from 3867 terminal cancer patients, who were registered in 34 inpatient palliative care services designated by the Ministry of Health, Welfare, and Family Affairs. Cox proportional hazard models were used to determine factors associated with the duration of survival after enrollment in palliative care services.
  
  
  RESULTS
  The median duration of survival after enrollment in palliative care services was 18 days. Male sex, liver cancer diagnosis, poor performance status, being covered by National Health Insurance, and being married were significantly associated with shorter duration of survival after enrollment, whereas a prostate cancer diagnosis was associated with longer survival.
  
  
  CONCLUSIONS
  Korean terminal cancer patients are referred to palliative care very late, and the timing appears to be influenced by some socioeconomic and medical factors. Interventions, such as physician education and establishing palliative care teams, are required to promote earlier referrals in Korea.
authors.affiliation: National Cancer Control Institute, National Cancer Center, Seoul, Republic of Korea.
authors.forename: Young Ji
authors.initials: YJ
authors.lastname: Baek
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Shin
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Jina
authors.initials: J
authors.lastname: Kang
authors.forename: Ha Na
authors.initials: HN
authors.lastname: Mo
authors.forename: Yang Hyeok
authors.initials: YH
authors.lastname: Kim
authors.forename: Sohee
authors.initials: S
authors.lastname: Kim
authors.forename: Kyu Won
authors.initials: KW
authors.lastname: Jung
authors.forename: Jisoo
authors.initials: J
authors.lastname: Joo
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007348:Insurance, Health; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010166:Palliative Care / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011788:Quality of Life; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012067:Religion; D056910:Republic of Korea / Q000453:epidemiology; D013315:Stress, Psychological / Q000517:prevention & control; D013534:Survival; D055815:Young Adult