Australasian haematologist referral patterns to palliative care: lack of consensus on when and why

Background:  Patients with haematological malignancies are not referred to palliative care services as frequently as those with solid cancers (non haematological malignancies). Aims:  The present study surveyed haematologists in Australia and New Zealand. We aimed to record theoret­ical referral times, identify problems with referral to palliative care and clarify elements used to decide whether a patient was ‘terminally ill’. Methods: A questionnaire based on the case‐histories of three patients (with acute leukaemia, lymphoma or mul­tiple myeloma) was distributed at the Haematology Society of Australia and New Zealand Congress 2000, Perth, Australia. Each case was divided into stages by transitional points in the illness to include issues or prognostic variables that may stimulate referral to ­palliative care. Questions were asked about: (i) referral ­triggers, (ii) problems previously experienced, (iii) definition of when the patient was ‘terminally ill’, (iv) prognostication difficulties and (v) communication about prognosis. Results: The response rate was 11%, which may represent up to 32% of Australian specialists. Eighty per cent had access to all types of palliative care services and refer for symptom control, regardless of illness stage. Twenty‐nine per cent had experienced difficulties in referring. There was a variation as to exactly when referral would occur and when each case was considered ‘terminally ill’. Reasons for early or later referral were explored. Prognostication difficulties were common. Conclusions: In theory there is a willingness to refer to palliative care, however this has yet to be translated to day‐to‐day practice. This may be due to prognostication difficulties, logistical factors and medical concerns. Models of referral are suggested for further study. (Intern Med J 2003; 33: 566−571)