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Use and timing of referral to specialized palliative care services for people with cancer : a mortality follow-back study among treating physicians in Belgium

Gaëlle Vanbutsele (UGent) , Luc Deliens (UGent) , Veronique Cocquyt (UGent) , Joachim Cohen, Koen Pardon (UGent) and Kenneth Chambaere (UGent)
(2019) PLOS ONE. 14(1).
Author
Organization
Abstract
Background : Referral to specialized palliative care services (SPCS) occurs often late in the illness trajectory but may differ across cancer types. We examined differences between cancer types in the use and timing of referral to specialized palliative care services (SPCS) and in the reasons for non-referral. Methods : We conducted a population-based mortality follow-back survey among physicians who certified a representative sample of deaths in Flanders, Belgium. We focused only on sampled death cases of cancer (n = 2392). The questionnaire asked about the use of the existing types of SPCS and the timing of referral to these services. Results : Response rate was 58% (1394/2392). Patients who died from breast, respiratory, head and neck, genitourinary or gastrointestinal cancer had higher chances of using SPCS compared to hematologic cancer patients. The most prevalent reason for non-referral was that regular care sufficiently addressed palliative and supportive care needs (51%). This differed significantly between cancer types ranging from 77,8% for breast cancer and 42.1% for hematologic cancer. A second prevalent reason for not using SPCS was that it was not meaningful (enough) (23.9%), particularly for hematologic malignancies (35,1%) and only in 5.3% for breast cancer. Conclusion : Differences in referral across different types of cancer were found. Referral is more often delayed or not initiated for patients with hematologic cancer, possibly due to differences in illness trajectory. An influencing reason is that physicians perceive palliative care as not meaningful or not meaningful enough for these patients which may be linked to the uncertainty in the disease trajectory of hematologic malignancies.
Keywords
OF-LIFE PRACTICES, SYMPTOM BURDEN, HEMATOLOGICAL MALIGNANCIES, PATIENT, INTEGRATION, OUTCOMES, HEALTH, EUTHANASIA, ENROLLMENT, BARRIERS

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MLA
Vanbutsele, Gaëlle et al. “Use and Timing of Referral to Specialized Palliative Care Services for People with Cancer : a Mortality Follow-back Study Among Treating Physicians in Belgium.” PLOS ONE 14.1 (2019): n. pag. Print.
APA
Vanbutsele, G., Deliens, L., Cocquyt, V., Cohen, J., Pardon, K., & Chambaere, K. (2019). Use and timing of referral to specialized palliative care services for people with cancer : a mortality follow-back study among treating physicians in Belgium. PLOS ONE, 14(1).
Chicago author-date
Vanbutsele, Gaëlle, Luc Deliens, Veronique Cocquyt, Joachim Cohen, Koen Pardon, and Kenneth Chambaere. 2019. “Use and Timing of Referral to Specialized Palliative Care Services for People with Cancer : a Mortality Follow-back Study Among Treating Physicians in Belgium.” Plos One 14 (1).
Chicago author-date (all authors)
Vanbutsele, Gaëlle, Luc Deliens, Veronique Cocquyt, Joachim Cohen, Koen Pardon, and Kenneth Chambaere. 2019. “Use and Timing of Referral to Specialized Palliative Care Services for People with Cancer : a Mortality Follow-back Study Among Treating Physicians in Belgium.” Plos One 14 (1).
Vancouver
1.
Vanbutsele G, Deliens L, Cocquyt V, Cohen J, Pardon K, Chambaere K. Use and timing of referral to specialized palliative care services for people with cancer : a mortality follow-back study among treating physicians in Belgium. PLOS ONE. 2019;14(1).
IEEE
[1]
G. Vanbutsele, L. Deliens, V. Cocquyt, J. Cohen, K. Pardon, and K. Chambaere, “Use and timing of referral to specialized palliative care services for people with cancer : a mortality follow-back study among treating physicians in Belgium,” PLOS ONE, vol. 14, no. 1, 2019.
@article{8589504,
  abstract     = {Background : Referral to specialized palliative care services (SPCS) occurs often late in the illness trajectory but may differ across cancer types. We examined differences between cancer types in the use and timing of referral to specialized palliative care services (SPCS) and in the reasons for non-referral. 
Methods : We conducted a population-based mortality follow-back survey among physicians who certified a representative sample of deaths in Flanders, Belgium. We focused only on sampled death cases of cancer (n = 2392). The questionnaire asked about the use of the existing types of SPCS and the timing of referral to these services. 
Results : Response rate was 58% (1394/2392). Patients who died from breast, respiratory, head and neck, genitourinary or gastrointestinal cancer had higher chances of using SPCS compared to hematologic cancer patients. The most prevalent reason for non-referral was that regular care sufficiently addressed palliative and supportive care needs (51%). This differed significantly between cancer types ranging from 77,8% for breast cancer and 42.1% for hematologic cancer. A second prevalent reason for not using SPCS was that it was not meaningful (enough) (23.9%), particularly for hematologic malignancies (35,1%) and only in 5.3% for breast cancer. 
Conclusion : Differences in referral across different types of cancer were found. Referral is more often delayed or not initiated for patients with hematologic cancer, possibly due to differences in illness trajectory. An influencing reason is that physicians perceive palliative care as not meaningful or not meaningful enough for these patients which may be linked to the uncertainty in the disease trajectory of hematologic malignancies.},
  articleno    = {e0210056},
  author       = {Vanbutsele, Gaëlle and Deliens, Luc and Cocquyt, Veronique and Cohen, Joachim and Pardon, Koen and Chambaere, Kenneth},
  issn         = {1932-6203},
  journal      = {PLOS ONE},
  keywords     = {OF-LIFE PRACTICES,SYMPTOM BURDEN,HEMATOLOGICAL MALIGNANCIES,PATIENT,INTEGRATION,OUTCOMES,HEALTH,EUTHANASIA,ENROLLMENT,BARRIERS},
  language     = {eng},
  number       = {1},
  pages        = {14},
  title        = {Use and timing of referral to specialized palliative care services for people with cancer : a mortality follow-back study among treating physicians in Belgium},
  url          = {http://dx.doi.org/10.1371/journal.pone.0210056},
  volume       = {14},
  year         = {2019},
}

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