title: Attitudes and referral patterns of lung cancer specialists in Europe to Specialized Palliative Care (SPC) and the practice of Early Palliative Care (EPC).
abstract: OBJECTIVE
  To examine availability of Palliative Care (PC) services and referral patterns of European Lung cancer specialists to PC.
  
  
  METHODS
  All members of the EORTC Lung Cancer Group (LCG) were asked via email to participate in an on-line survey.
  
  
  RESULTS
  50 out of 170 (29.4%) replied: 24 medical oncologists, 14 radiation/clinical oncologists, 11 pulmonologists and 1 thoracic surgeon. All but two of respondents (96%) had access to at least one component of PC services. In terms of referral of patients to PC almost 75% of respondents would refer most of their patients when there were no treatment options or at the end of life, while only 22% would refer patients at earlier stages of disease. Barriers for referral to PC were negative attitudes of patients to PC (26%), lack of availability of PC services (20%), lack of expertise of PC physicians(18%), the belief that referral to PC signifies abandoning patients (8%), and that PC specialists discourage active oncological therapy (8%). Whilst most of the respondents expressed positive attitudes, 12-22% had overtly negative attitudes towards PC. Seventy-eight (78%) of respondents expressed an interest to participate in a trial of early PC (EPC).
  
  
  CONCLUSIONS
  Despite good availability of SPC services at institutions of members of the EORTC LCG, and most respondents expressing positive attitudes towards PC, their practice involved referral of patients to PC late in the disease trajectory, hence Lung Cancer specialists in Europe have not adopted the practice of EPC concurrent with active oncological care.
authors.affiliation: Bank of Cyprus Oncology Centre, Nicosia, Cyprus.
authors.forename: Haris
authors.initials: H
authors.lastname: Charalambous
authors.affiliation: EORTC Headquarters, Brussels, Belgium.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Pallis
authors.affiliation: EORTC Headquarters, Brussels, Belgium.
authors.forename: Baktiar
authors.initials: B
authors.lastname: Hasan
authors.affiliation: Royal Marsden Hospital, London, UK ; EORTC Lung Cancer Group, Brussels, Belgium.
authors.forename: Mary
authors.initials: M
authors.lastname: O'Brien
keywords: Attitudes; Lung cancer specialists; Referrals; Specialized palliative care