Identifying factors affecting utilization of an inpatient palliative care service: a physician survey.

Abstract

Little is currently known about physicians': (1) level of involvement in and comfort delivering palliative care in the inpatient setting, (2) perceived barriers to referring patients to an inpatient Palliative Care Consult Service (PCCS), and (3) attitudes regarding palliative care. Eligible participants included physicians who regularly provide inpatient care at New York Presbyterian Hospital. Two groups of physicians were targeted: those that had referred 1 or more patient to the PCCS and those that had not. Face-to-face interviews were conducted to collect information regarding participants' demographic and practice characteristics, and the outcomes described above. A total of 74 physicians were enrolled (50 referring physicians and 24 nonreferring physicians). Most respondents irrespective of referral status reported high levels of involvement in and comfort managing many symptoms that occur commonly in patients with advanced disease, but were less comfortable managing delirium and patients' psychosocial and existential needs. The most commonly endorsed barrier to referral was the patient and/or family's perceived unrealistic expectations regarding disease prognosis (by 70%). Most participants had generally favorable attitudes about palliative care, but nonreferring (versus referring) physicians were significantly more likely to disagree with the statement that a palliative care specialist is the best person to coordinate the palliative care of patients with advanced disease (29% versus 8%, p < 0.05). Our results suggest possible avenues for building more effective partnerships between palliative care consult services and referring physicians and highlight the need for interventions designed to facilitate physician-patient communication about palliative care.