Appropriate referral timing to specialized palliative care service: survey of bereaved families of cancer patients who died in palliative care units

Abstract

Few studies have investigated appropriate referral timing of specialized palliative care (SPC) from the perspective of cancer patients’ and families’ experiences. We aimed to clarify appropriate SPC referral timing for patients with advanced cancer and their families. We used data from a nationwide bereaved family survey in Japan. We sent a questionnaire to 999 bereaved families of cancer patients who died in 164 palliative care units (PCUs) and analyzed the first SPC referral timing and how patients evaluated it. We defined SPC as outpatient or inpatient palliative care service comprising certified palliative care physicians, advanced-practice nurses, and multidisciplinary practitioners. Finally, 51.6% (n = 515) of all responses were analyzed. The SPC referral timing was evaluated as appropriate (26.1%), late or too late (20.2%), early or too early (1.2%), or none of these (52.5%). Of these, 32.3% reported that they were referred to an SPC when diagnosed with advanced or incurable cancer or during anti-cancer treatment, and 62.6% reported they were referred after anti-cancer treatment. Patient-perceived appropriateness of SPC referral timing was associated with their good death process. After excluding “none of these” responses, a significantly higher proportion of respondents who reported being referred to SPC at diagnosis and during anti-cancer treatment evaluated the response timing as appropriate, compared to those who reported being referred after anti-cancer treatment. Appropriate timing for SPC referrals relates to quality of death; findings suggest that appropriate timing is at the time of diagnosis or during anti-cancer treatment.

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https://doi.org/10.1007/s00520-021-06493-2
ORIGINAL ARTICLE
Appropriate referral timing tospecialized palliative care service:
survey ofbereaved families ofcancer patients who died inpalliative
care units
KeitaTagami1,2 · KentoMasukawa3· AkiraInoue1,2· TatsuyaMorita4· YusukeHiratsuka1,2· MamikoSato2·
KatsuraKohata2· NoriakiSatake2· YoshiyukiKizawa5· SatoruTsuneto6· YasuoShima7· MitsunoriMiyashita3
Received: 2 June 2021 / Accepted: 7 August 2021
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021
Abstract
Few studies have investigated appropriate referral timing of specialized palliative care (SPC) from the perspective of cancer
patients’ and families’ experiences. We aimed to clarify appropriate SPC referral timing for patients with advanced cancer
and their families. We used data from a nationwide bereaved family survey in Japan. We sent a questionnaire to 999 bereaved
families of cancer patients who died in 164 palliative care units (PCUs) and analyzed the first SPC referral timing and how
patients evaluated it. We defined SPC as outpatient or inpatient palliative care service comprising certified palliative care
physicians, advanced-practice nurses, and multidisciplinary practitioners. Finally, 51.6% (n = 515) of all responses were
analyzed. The SPC referral timing was evaluated as appropriate (26.1%), late or too late (20.2%), early or too early (1.2%),
or none of these (52.5%). Of these, 32.3% reported that they were referred to an SPC when diagnosed with advanced or
incurable cancer or during anti-cancer treatment, and 62.6% reported they were referred after anti-cancer treatment. Patient-
perceived appropriateness of SPC referral timing was associated with their good death process. After excluding “none of
these” responses, a significantly higher proportion of respondents who reported being referred to SPC at diagnosis and
during anti-cancer treatment evaluated the response timing as appropriate, compared to those who reported being referred
after anti-cancer treatment. Appropriate timing for SPC referrals relates to quality of death; findings suggest that appropriate
timing is at the time of diagnosis or during anti-cancer treatment.
Keywords Integration of oncology and palliative care· Specialized palliative care· Referral timing of palliative care·
Early palliative care· Cancer patient experience
* Keita Tagami
keita.tagami.d7@tohoku.ac.jp
1 Department ofPalliative Medicine, Tohoku University
Graduate School ofMedicine, 2-1 Seiryo-machi, Aoba-ku,
Sendai, Miyagi980-8575, Japan
2 Department ofPalliative Medicine, Tohoku University
Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai,
Miyagi980-8575, Japan
3 Department ofPalliative Nursing, Tohoku University
Graduate School ofMedicine, 2-1 Seiryo-machi, Aoba-ku,
Sendai, Miyagi980-8575, Japan
4 Department ofPalliative andSupportive Care, Palliative
Care Team, Seirei Mikatahara General Hospital, 3453
Mikatahara-cho, Kita-ku, Hamamatsu,Shizuoka433-8558,
Japan
5 Department ofPalliative Medicine, Kobe University
Hospital, 1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo650-0017,
Japan
6 Department ofHuman Health Sciences, Kyoto University
Graduate School ofMedicine, Yoshida-Konoe-cho,
Sakyo-ku, Kyoto606-8501, Japan
7 Tsukuba Medical Center Hospital, 1-3-1, Amakubo,
Tsukuba, Ibaraki305-8558, Japan
/ Published online: 21 August 2021
Supportive Care in Cancer (2022) 30:931–940
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