title: Specialists' experiences and perspectives on the timing of referral to palliative care: a qualitative study.
abstract: BACKGROUND
  Specialist referral practices regarding palliative care are variable and their decision-making practices regarding timing and communication remains an under-researched issue. More effective referral practices have been shown to enhance patient and carer experiences at the end of life, reduce the burden on pre-palliative care services, and even extend life expectancy in some cases.
  
  
  OBJECTIVE
  The aim of this study was to examine the logics underpinning the timing of referral to palliative care according to a range of medical specialists in a regional center on the east coast of Australia, in order to facilitate improvements in referral practices.
  
  
  METHODS
  We conducted semi-structured, qualitative interviews with 20 medical specialists and carried out a thematic analysis of the interview data, utilising the framework analysis approach and NVivo 9 software. Key themes were tested for rigour through inter-rater reliability.
  
  
  RESULTS
  The major themes identified within this analysis of the interviews were: a) strategies for preparing for palliative care and the importance of planning timely referrals; b) perception of inter-professional variation and reasons for delayed or difficult referrals; and c) the importance of inter-specialty communication and cross-disciplinary dialogue.
  
  
  CONCLUSIONS
  Significant barriers exist to the timely referral to palliative care, and, in order to improve patient and care quality of life and lessen clinical difficulties, further work is needed to develop streamlined practices that are sensitive to specialty needs and patient desires.
authors.affiliation: School of Social Science, University of Queensland, Queensland, Australia.
authors.forename: Alex
authors.initials: A
authors.lastname: Broom
authors.forename: Emma
authors.initials: E
authors.lastname: Kirby
authors.forename: Phillip
authors.initials: P
authors.lastname: Good
authors.forename: Julia
authors.initials: J
authors.lastname: Wootton
authors.forename: Jon
authors.initials: J
authors.lastname: Adams
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D003657:Decision Making; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D008297:Male; D010166:Palliative Care; D057240:Patient Preference; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D011788:Quality of Life; D012017:Referral and Consultation; D013038:Specialization; D013997:Time Factors