Abstract
Context: Current guidelines recommend early referral to palliative care for patients with advanced cancer; however, no studies have examined the optimal timing of referral from the patients' perspective. Objectives: To examine patients' perceptions of timeliness of referral and its association with survival among patients with advanced cancer referred to an outpatient supportive care (SC) clinic. Methods: This cross-sectional prospective study in an SC clinic at a comprehensive cancer center included patients aged 18 years or older with locally advanced, recurrent, or metastatic cancer. Patients were asked to complete an anonymous survey regarding the timeliness and perceived usefulness of SC referral within four weeks of their first SC consultation. Results: Of 253 eligible patients, 209 (83%) enrolled in the study and 200 completed the survey. Median survival was 10.3 months. Most patients (72%) perceived that referral occurred “just in time,” whereas 21% felt it was “late,” and 7% felt “early.” A majority (83%) found the referral useful, and 88% would recommend it to other patients with cancer. The perception of being referred early was associated with lower reported levels of pain (P = 0.043), fatigue (P = 0.004), drowsiness (P = 0.005), appetite loss (P = 0.041), poor well-being (P = 0.041), and lower physical (P = 0.001) and overall symptom distress (P = 0.001). No other associations were found between perceived timeliness and usefulness and patients' baseline characteristics. Conclusion: Most patients with a median survival of 10 months perceived that SC referral was timely and useful. Patient care needs rather than the timing of advanced cancer diagnosis drove this perception of referral timing. Lower symptom burden was associated with the perception of being referred to early.
Original language | English (US) |
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Pages (from-to) | 275-281 |
Number of pages | 7 |
Journal | Journal of pain and symptom management |
Volume | 58 |
Issue number | 2 |
DOIs | |
State | Published - Aug 2019 |
Keywords
- Supportive care
- palliative care
- patients
- perceptions
- referral
ASJC Scopus subject areas
- General Nursing
- Clinical Neurology
- Anesthesiology and Pain Medicine
MD Anderson CCSG core facilities
- Biostatistics Resource Group