title: Palliative care case managers in primary care: a descriptive study of referrals in relation to treatment aims.
abstract: BACKGROUND
  Three important elements of the World Health Organization (WHO) definition of palliative care are: 1) it includes patients who may have cure or life prolongation as treatment aims besides palliative care; 2) it is not exclusively for cancer patients; and 3) it includes attention to the medical, psychological, social, and spiritual needs of the patients and their families. Case managers (nurses with expertise in palliative care) may assist generalist primary care providers in delivery of good palliative care.
  
  
  OBJECTIVE
  This study investigates the referral of patients to case managers in primary care with regard to the three elements mentioned: diagnosis, treatment aims, and needs as reflected in reasons given for referral.
  
  
  METHODS
  In this cross-sectional survey in primary care among case managers and referrers to case management, case managers completed questionnaires for 687 patients; referrers completed 448 (65%).
  
  
  RESULTS
  Most patients referred have a combination of treatment aims (69%). Life expectancy and functional status of patients are lower for those with a treatment aim of palliation. Almost all (96%) of those referred are cancer patients. A need for psychosocial support is frequently given as a reason for referral (66%) regardless of treatment aim.
  
  
  CONCLUSIONS
  Referrals to case managers reflect two of three elements of the WHO definition. Mainly, patients are referred for support complementary to medical care, and relatively early in their disease trajectory. However, most of those referred are cancer patients. Thus, to fully reflect the definition, broadening the scope to reach other patient groups is important.
authors.affiliation: 1 Department of Public and Occupational Health, VU University Medical Center , Amsterdam, the Netherlands .
authors.forename: Annicka G M
authors.initials: AG
authors.lastname: van der Plas
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
authors.forename: Anneke L
authors.initials: AL
authors.lastname: Francke
authors.forename: Wim J J
authors.initials: WJ
authors.lastname: Jansen
authors.forename: Kris C
authors.initials: KC
authors.lastname: Vissers
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D000368:Aged; D019090:Case Management / Q000458:organization & administration / Q000592:standards*; D006040:Goals; D006699:Home Care Services / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008017:Life Expectancy; D020380:Needs Assessment; D009369:Neoplasms / Q000523:psychology / Q000628:therapy; D009426:Netherlands; D010166:Palliative Care / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D011368:Professional-Family Relations; D011369:Professional-Patient Relations; D011788:Quality of Life; D012017:Referral and Consultation; D012944:Social Support; D011795:Surveys and Questionnaires