title: Referral practices of oncologists to specialized palliative care.
abstract: OBJECTIVE
  To describe current referral practices of oncologists to specialized palliative care (SPC) and define demographic characteristics, practice situations, and opinions associated with referral.
  
  
  METHODS
  Physician members of the Canadian Association of Medical Oncologists, Canadian Association of Radiation Oncologists, and Canadian Society of Surgical Oncology were invited to participate in an anonymous survey assessing SPC referral practices. Participants received two e-mailed and two mailed invitations.
  
  
  RESULTS
  The response rate was 72% (603 of 839 physicians); 37% were medical oncologists/hematologists, 50% were radiation oncologists, and 12% were surgical oncologists. Ninety-four percent reported that SPC was available to them, but only 37% reported that these services accepted patients on chemotherapy. Eighty-four percent referred terminally ill patients usually/always, but generally for uncontrolled symptoms or discharge planning late in the disease course. One third would refer to SPC earlier if it was renamed supportive care. Predictors of higher referral frequency included comprehensiveness of available SPC services (P = .004), satisfaction with SPC availability (P < .001), SPC acceptance of patients receiving chemotherapy (P < .001), and oncologist ease with referring patients to a palliative care service before they were close to death (P < .001). Controlling for specialty, predictors of referral at diagnosis or during chemotherapy, rather than later, included satisfaction with SPC service availability (P < .001) and SPC service acceptance of patients on chemotherapy (P < .001).
  
  
  CONCLUSIONS
  Oncologists referred patients frequently to SPC, but generally late in the disease course for patients with uncontrolled symptoms. Availability of comprehensive SPC, especially for patients receiving chemotherapy, and persisting definitional issues seem to be the main barriers preventing timely referral.
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Wentlandt
authors.forename: Monika K
authors.initials: MK
authors.lastname: Krzyzanowska
authors.forename: Nadia
authors.initials: N
authors.lastname: Swami
authors.forename: Gary M
authors.initials: GM
authors.lastname: Rodin
authors.forename: Lisa W
authors.initials: LW
authors.lastname: Le
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
mesh_terms: D001291:Attitude of Health Personnel; D017321:Clinical Trials, Phase I as Topic / Q000379:methods*; D017322:Clinical Trials, Phase II as Topic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000379:methods* / Q000458:organization & administration; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011364:Professional Practice; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires