Lung cancer is the leading cause of death from cancer in Australia with the majority of patients diagnosed with late stage incurable disease. Although there is evidence of patient benefit from early involvement with specialist palliative care, this may not translate into clinical practice.
The aim of this study was to explore clinicians’ perceptions and attitudes to Palliative Care referral. A modified validated self-report questionnaire (Johnson, 2008) was given to clinicians (doctors, nurses and allied health) involved in the care of patients with incurable lung cancer, working in the multi-disciplinary lung cancer teams at three teaching hospitals in metropolitan Melbourne. 55 questionnaires were distributed and 42 completed (76% response rate).
93% of respondents agreed that early referral to Palliative Care is beneficial to patients and 95% agreed that Palliative Care can benefit patients receiving active treatment. However, only 60% of respondents agreed that all advanced cancer patients should be referred to Palliative Care. When asked for the main reasons for not referring to Palliative Care, 60% agreed they do not refer when the patient has no symptoms and 60% agreed they do not refer if they can manage the patients’ symptoms themselves. However, just 38% of clinicians agreed they were well trained to take care of the symptoms of advanced cancer patients. Issues related to patients not understanding or accepting their prognosis were cited as barriers to referral by a third of clinicians.
Clinicians involved in the care of patients with incurable lung cancer have positive perceptions and attitudes to Palliative Care but this may not translate into routine referral of all patients with incurable lung cancer. In order to make referral routine, we need education around the perception that only patients with unmanageable symptoms benefit from referral to Palliative Care. In addition, further training of clinicians about symptom management appears desirable.