Palliative care referrals by general practitioners in the United Kingdom: an observational study of cancer patients who died in 2000-2008
1King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK,2King’s College London,Division of Health and Social Care Research, London, UK
Enabling more people access to palliative care(PC) service needs professional inputs from general practitioners(GP). However, it is poorly understood about when and how British GPs refer patients for specialist PC. This study aims to describe the trend of PC referrals and the associated factors.
The data was extracted from the Clinical Practice Research Datalink(CPRD). Patients with a common cancer diagnosis(lung, head&neck, colorectal, breast, prostate), and died in between 2000 and 2008 were included. We reviewed the referral records of the cancer patients, covering a 100 year period dated back to 1909. Data were described using count and proportion. Factors associated with early PC referral(more than one year survival) were evaluated using adjusted odds ratio(AOR) derived from multiple logistic regression modeling.
In a total of 356,822 referral records for 27,814(93%) out of 29,810 cancer patients who died in 2000-2008, PC referrals accounted for 0.34% (95% Confidence Interval(CI): 0.32-0.35%). PC referrals first appeared in the system from 1996(0.01%; 95%CI: 0.00-0.02%), thereafter increased at a slow rate to 3.2%(95%CI: 2.5-3.9%) in 2008. 81.0%(95%CI: 78.7-83.2%) and 19.1%(95%CI: 16.8-21.7%) of the PC referrals occurred in the last year and beyond last year, respectively. Those who are aged under 50(AOR vs 80+ 2.66, 95%CI: 1.25-5.65), with a diagnosis of breast or prostate cancer(AORs vs lung cancer: 3.94(95%CI: 2.20-7.05) and 3.71(95%CI: 2.06-6.71)), living in the most deprived area(AOR vs least deprived 0.29, 95%CI: 0.13-0.62), or registered with a GP in Scotland or Wales (AORs vs Southern Cluster: 3.61(95%CI: 1.55-8.41) and 2.10(95%CI: 1.09-4.03) were more likely to have early PC referral.
PC referral by GPs increased over time but still rather low; old age, cancer site in lung, colorectal or in head and neck, people living in deprived area or registered with a practice in England are disadvantaged for early PC referral. Future studies need to understand the underlying reasons to inform end of life improvement.