TY - JOUR
T1 - Pattern and predictors of outpatient palliative care referral among thoracic medical oncologists
AU - Hui, David
AU - Kilgore, Kelly
AU - Park, Minjeong
AU - Liu, Diane
AU - Kim, Yu Jung
AU - Park, Ji Chan
AU - Fossella, Frank
AU - Bruera, Eduardo
N1 - Publisher Copyright:
© AlphaMedPress 20182018.
PY - 2018
Y1 - 2018
N2 - Background. There is significant variation in access to palliative care. We examined the pattern of outpatient palliative care referral among thoracic medical oncologists and identified oncologist characteristics associated with greater referral. Materials and Methods. We retrieved data on all patients who died of advanced thoracic malignancies at our institution between January 1, 2007, and December 31, 2012. Using median as a cutoff, we defined two groups (high-referring and low-referring oncologists) based on their frequency of referral. We examined various oncologist-and patient-related characteristics associated with outpatient referral. Results. Of 1,642 decedents, 444 (27%) had an outpatient palliative care referral. The median proportion of referral among 26 thoracic oncologists was 30% (range 9%–45%; median proportion of high-referring 37% vs. low-referring 24% when divided into two groups at median). High-referring oncologists were significantly younger (age 45 vs. 56) than low-referring oncologists; they were also significantly more likely to refer patients earlier (median interval between oncology consultation and palliative care consultation 90 days vs. 170 days) and to refer those without metastatic disease (7% vs. 2%). In multivariable mixed-effect logistic regression, younger oncologists (odds ratio [OR] 5 0.97 per year increase, 95% confidence interval [CI] 0.95–0.995), younger patients (OR 5 0.98 per year increase, 95% CI 0.97–0.99), and nonmetastatic disease status (OR 5 0.48, 95% CI 0.29–0.78) were significantly associated with outpatient palliative care referral. Conclusion. The pattern of referral to outpatient palliative care varied widely among thoracic oncologists. Younger oncologists were not only referring a higher proportion of patients, but also referring patients earlier in the disease trajectory.
AB - Background. There is significant variation in access to palliative care. We examined the pattern of outpatient palliative care referral among thoracic medical oncologists and identified oncologist characteristics associated with greater referral. Materials and Methods. We retrieved data on all patients who died of advanced thoracic malignancies at our institution between January 1, 2007, and December 31, 2012. Using median as a cutoff, we defined two groups (high-referring and low-referring oncologists) based on their frequency of referral. We examined various oncologist-and patient-related characteristics associated with outpatient referral. Results. Of 1,642 decedents, 444 (27%) had an outpatient palliative care referral. The median proportion of referral among 26 thoracic oncologists was 30% (range 9%–45%; median proportion of high-referring 37% vs. low-referring 24% when divided into two groups at median). High-referring oncologists were significantly younger (age 45 vs. 56) than low-referring oncologists; they were also significantly more likely to refer patients earlier (median interval between oncology consultation and palliative care consultation 90 days vs. 170 days) and to refer those without metastatic disease (7% vs. 2%). In multivariable mixed-effect logistic regression, younger oncologists (odds ratio [OR] 5 0.97 per year increase, 95% confidence interval [CI] 0.95–0.995), younger patients (OR 5 0.98 per year increase, 95% CI 0.97–0.99), and nonmetastatic disease status (OR 5 0.48, 95% CI 0.29–0.78) were significantly associated with outpatient palliative care referral. Conclusion. The pattern of referral to outpatient palliative care varied widely among thoracic oncologists. Younger oncologists were not only referring a higher proportion of patients, but also referring patients earlier in the disease trajectory.
KW - Ambulatory care
KW - Health knowledge, attitudes, practice
KW - Health services research
KW - Neoplasms
KW - Palliative care
KW - ReferralReferral andand consultation
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U2 - 10.1634/theoncologist.2018-0094
DO - 10.1634/theoncologist.2018-0094
M3 - Article
C2 - 29895629
AN - SCOPUS:85054892484
SN - 1083-7159
VL - 23
SP - 1230
EP - 1235
JO - Oncologist
JF - Oncologist
IS - 10
ER -