title: Lung cancer physicians' referral practices for palliative care consultation.
abstract: BACKGROUND
  Integration of palliative care with standard oncologic care improves quality of life and survival of lung cancer patients. We surveyed physicians to identify factors influencing their decisions for referral to palliative care.
  
  
  METHODS
  We provided a self-administered questionnaire to physicians caring for lung cancer patients at five medical centers. The questionnaire asked about practices and views with respect to palliative care referral. We used multiple regression analysis to identify predictors of low referral rates (<25%).
  
  
  RESULTS
  Of 155 physicians who returned survey responses, 75 (48%) reported referring <25% of patients for palliative care consultation. Multivariate analysis, controlling for provider characteristics, found that low referral rates were associated with physicians' concerns that palliative care referral would alarm patients and families [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.21-0.98], while the belief that palliative care specialists have more time to discuss complex issues (OR 3.07, 95% CI 1.56-6.02) was associated with higher rates of referral.
  
  
  CONCLUSIONS
  Although palliative care consultation is increasingly available and recommended throughout the trajectory of lung cancer, our data indicate it is underutilized. Understanding factors influencing decisions to refer can be used to improve integration of palliative care as part of lung cancer management.
authors.affiliation: Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai School of Medicine, New York, USA. cardinale.smith@mssm.edu
authors.forename: C B
authors.initials: CB
authors.lastname: Smith
authors.forename: J E
authors.initials: JE
authors.lastname: Nelson
authors.forename: A R
authors.initials: AR
authors.lastname: Berman
authors.forename: C A
authors.initials: CA
authors.lastname: Powell
authors.forename: J
authors.initials: J
authors.lastname: Fleischman
authors.forename: J
authors.initials: J
authors.lastname: Salazar-Schicchi
authors.forename: J P
authors.initials: JP
authors.lastname: Wisnivesky
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D011364:Professional Practice; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012044:Regression Analysis; D011795:Surveys and Questionnaires