Originally published as JCO Early Release 10.1200/JCO.2005.12.107 on February 22 2005

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Late Referrals to Specialized Palliative Care Service in Japan

From the Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatabara Hospital; Palliative Medicine, Shizuoka General Hospital, Shizuoka; Department of Psychiatry, Nagoya City University Medical School, Nagoya; Psycho-Oncology Division, and Psychiatry Division, National Cancer Center Research Institute East, Chiba; Hospice, Yodogawa Christian Hospital, Osaka; Institute of Clinical Medicine, University of Tsukuba, Ibaragi; Hiroshima Palliative Care Promotion Center, Hiroshima; Department of Internal Medicine and Palliative Care, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo; Department of Palliative Medicine, Tohoku University Hospital, Miyagi; Palliative Care Unit, Kawasaki Social Insurance Hospital, Kanagawa, Japan

Address reprint requests to Tatsuya Morita, MD, Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatabara Hospital, 3453 Mikatabara-cho, Hamamatsu, Shizuoka 433-8558, Japan; e-mail: seireihc{at}jt6.so-net.ne.jp

PURPOSE: To clarify the bereaved family's perceptions about the appropriateness of timing when physicians first referred patients to palliative care units, and to identify the factors contributing to family-perceived late referrals.

SUBJECTS AND METHODS: A multicenter questionnaire survey was conducted on 630 bereaved family members of cancer patents who were admitted to palliative care units in Japan. A total of 318 responses were analyzed (effective response rate, 62%).

RESULTS: Half of the bereaved family members regarded the timing of referrals to palliative care units as late or very late, while less than 5% of families reported early referrals (very late [19%, n = 59], late [30%, n = 96], appropriate [48%, n = 151], early [1.6%, n = 5], and very early [2.2%, n = 7]). Multiple regression analyses revealed that the independent determinants of family-perceived late referrals were: family belief before admission that palliative care shortens the patient's life, insufficient in-advance discussion about preferred end-of-life care between patients/families and physicians, families' insufficient preparation for changes of patient conditions, and hospital admission before referrals.

CONCLUSION: In Japan, the timing of referrals to palliative care units was late or very late from the families' perspectives. The independent determinants of family-perceived late referrals were: family misconception about palliative care, inadequate communication with physicians, and families' insufficient preparation for deterioration of patients' conditions. Systematic strategies to overcome these barriers would contribute to providing appropriate palliative care at all stages of cancer.

Supported by a Health and Labor Sciences Research Grant for Clinical Research for Evidenced Based Medicine.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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