Referral patterns of nonmalignant patients to an Irish specialist palliative medicine service: a retrospective review.
BACKGROUND
Our perception is that the proportion of referrals made to the specialist palliative medicine service (SPMS) in our institution for patients with a primary diagnosis of nonmalignant disease is high and that these patients are often referred late in their illness. We aimed to review the symptom burden and referral patterns of patients with a noncancer diagnosis to the SPMS in our centre.


METHODS
All new non-malignant referrals to the SPMS in 2009 were included. Data were collected from patients' medical records and analyzed using Excel.


RESULTS
Ninety-two referrals were identified: 60 (65%) female, 32 (35%) male. Mean age 76.5 years (21-92). Reasons for referral included: end-of-life care (n=55, 60%), symptom control (n=23, 25%), home care support (n=13, 14%) and psychological support (n=1, 1%). Mean time from admission to referral was 24.9 days (<1-165). Fifty-six (61%) patients were commenced on a syringe driver (CSCI), with a mean time spent on a CSCI of 2.8 days (< 1-17). Primary outcomes included: death (n=72, 78.5%), home discharge (n=9, 10%), discharge to another care institution (n=6, 6.5%), discharge from service (n=3, 3%) and hospice transfer (n=2, 2%). Mean time from referral to outcome was 4.6 days (<1-35).


CONCLUSIONS
The proportion of noncancer patients referred to the SPMS is our institution is high. This study confirms that nonmalignant referrals are commonly sent to the SPMS when patients are actively dying or very imminently dying. Further education of colleagues is warranted in the role of the SPMS, particularly with regard to earlier referral.
Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Canada. drelainewallace@gmail.com
Elaine M
EM
Wallace
Eoin
E
Tiernan
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019452:Terminally Ill / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult