title: Timing and Outcome of Referral to the First Stand-Alone Palliative Care Center in the Eastern Mediterranean Region, the Palliative Care Center of Kuwait.
abstract: BACKGROUND
  Compared to other regions of the world, palliative care (PC) in the Eastern Mediterranean region is at an earlier stage of development. The Palliative Care Center of Kuwait (PCC-K) was established a few years ago as the first stand-alone PC center in the region. This study was conducted to investigate the timing of referral to the PCC-K and its outcome.
  
  
  METHODS
  Retrospective review of referrals to the PCC-K during its first 3 years of action. Late referral was defined as referral during the last 30 days of life.
  
  
  RESULTS
  During the 3-year period, 498 patients with cancer were referred to the PCC-K of whom 467 were eligible for analysis. Referral was considered late in 58% of patients. Nononcology facilities were more likely to refer patients late when compared to oncology facilities ( P = .033). The palliative performance scale (PPS) was ≤30 in 59% of late referrals and 21% in earlier referrals ( P < .001). Among 467 referred patients, 342 (73%) were eligible for transfer to the PCC-K, 102 (22%) were ineligible, and 23 (5%) died before assessment by the PCC-K consultation team. From the 342 eligible patients, the family caregivers refused the transfer of 64 (19%) patients to the PCC-K.
  
  
  CONCLUSIONS
  Patients are frequently referred late to the PCC-K. Further research to identify barriers to PC and its early integration in Kuwait is required. The PPS may be useful in identifying late referrals.
authors.affiliation: 1 Palliative Care Center of Kuwait, Kuwait.
authors.forename: Khaled
authors.initials: K
authors.lastname: Al-Saleh
authors.affiliation: 1 Palliative Care Center of Kuwait, Kuwait.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Al-Awadi
authors.affiliation: 1 Palliative Care Center of Kuwait, Kuwait.
authors.forename: Najla A
authors.initials: NA
authors.lastname: Soliman
authors.affiliation: 1 Palliative Care Center of Kuwait, Kuwait.
authors.forename: Sobhy
authors.initials: S
authors.lastname: Mostafa
authors.affiliation: 1 Palliative Care Center of Kuwait, Kuwait.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Mostafa
authors.affiliation: 1 Palliative Care Center of Kuwait, Kuwait.
authors.forename: Wafaa
authors.initials: W
authors.lastname: Mostafa
authors.affiliation: 2 Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine (NEMROCK), Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Samy A
authors.initials: SA
authors.lastname: Alsirafy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007730:Kuwait; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D000070659:Patient Comfort; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013727:Terminal Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D013997:Time Factors; D055815:Young Adult
keywords: cancer; eastern mediterranean region; kuwait; palliative care; palliative performance scale; referral timing