Australian general practitioners' and oncology specialists' perceptions of barriers and facilitators of access to specialist palliative care services

Purpose: Doctors in Australia play an important role in facilitating access to specialist palliative care (SPC) services for people with advanced cancer. This study aimed to describe doctors' perceptions of barriers to referring patients for SPC, and to identify triggers and facilitators for referral. Method: Forty semistructured telephone interviews were conducted with doctors involved in the care of people with advanced cancer from a variety of settings. Results: Six themes were identified: disease and treatment; psychosocial; communication and interpersonal issues; health services issues; timing; and, health professionals' skills. All doctors considered the presence and complexity of physical symptoms, stage of the disease and treatment orientation as important in decisions to refer for SPC. Less important were the psychosocial well-being and cultural characteristics of the person with cancer and their family. Factors reportedly affecting referral and access included health professionals' ability to communicate openly and honestly about disease progression, availability and location of SPC resources and doctors' expertise. Divergent views were expressed about appropriate timing for access. The predominant view that SPC is for management of physical symptoms may result in nonreferral of those who have complex problems without physical symptoms. Conclusions: Given the complex relationship between psychological and physical well-being and health-related quality of life, it is important that all factors contributing to patient well-being are identified. Routine use of objective measures of unmet and complex needs may help identify people who are likely to most benefit from SPC and optimize access, regardless of timing, stage of disease, and treatment orientation