title: Medical specialists' motivations for referral to specialist palliative care: a qualitative study.
abstract: OBJECTIVE
  The decision to refer a patient to palliative care is complex and often highly variable between medical specialists. In this paper, we examine medical specialists' motivations and triggers underpinning decision-making around referral to palliative care in order to facilitate improvements in referral practices.
  
  
  METHODS
  We completed semistructured, qualitative interviews with 20 referring medical specialists. Medical specialists were recruited from a range of specialties in a major metropolitan area in Australia. Participants were sampled through having referred at least one patient to the specialist palliative care unit during the previous 12 months. Analysis consisted of the framework approach augmented by NVivo 9 data analysis software. Key themes were identified and tested for rigour through inter-rater reliability and constant comparison.
  
  
  RESULTS
  The major motivations/triggers identified were: (a) disease-based (eg, pain management and symptom control); (b) pre-emptive/strategic (eg, anticipation of need, preparatory objective); (c) crisis/parallel (eg, physical and psychosocial issues); and (d) team-based (eg, referral as policy/team strategy).
  
  
  CONCLUSIONS
  Referral to palliative care is motivated by a range of individual, interpersonal and organisational factors. In order to improve the care and quality of life of patients and family caregivers, further work is needed to develop streamlined practices that are sensitive to physical and psychosocial considerations, and patient/family caregiver desires.
authors.affiliation: School of Social Science, The University of Queensland, St Lucia, Brisbane, Queensland, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Kirby
authors.affiliation: School of Social Science, The University of Queensland, St Lucia, Brisbane, Queensland, Australia.
authors.forename: Alex
authors.initials: A
authors.lastname: Broom
authors.affiliation: Palliative Care, St Vincent's Hospital, Brisbane, Queensland, Australia.
authors.forename: Phillip
authors.initials: P
authors.lastname: Good
authors.affiliation: Palliative Care, St Vincent's Hospital, Brisbane, Queensland, Australia.
authors.forename: Julia
authors.initials: J
authors.lastname: Wootton
authors.affiliation: Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
authors.forename: Jon
authors.initials: J
authors.lastname: Adams
mesh_terms: D001291:Attitude of Health Personnel; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine; D009042:Motivation; D010166:Palliative Care; D012017:Referral and Consultation
keywords: Communication; Hospice care; Prognosis; Supportive care; Terminal care