Discordant Beliefs and Practices of Physicians Referring Cancer Patients to Palliative Care

Objectives: We aimed to examine the concordance between beliefs and practices of physicians regarding the timing of referring cancer patients to a PC team. Methods: We reviewed records of cancer deaths in a palliative care unit (PCU) over three years. Physicians who initiated the referral to PC completed a questionnaire. The referral time was categorized into early (> 90 days), intermediate (31-90 days) or late (<= 30 days). Results: For 208 cancer deaths (63% females), the median age was 55 years. The median referral time was 33 days. Only 9.6% of patients were referred early, while the majority were either referred late (47.1%) or fell in the intermediate category (43.3%). All of the referring physicians believed that a PC service is essential in an oncology center and 73.7% stated that cancer patients should be referred to PC at diagnosis or when cancer becomes incurable. No patient- or physician-related factors were significantly associated with the referral time. Conclusions: Despite the unanimous belief among this group of physicians that cancer patients should be referred to PC at or before diagnosing its incurability, initiation of early referrals to PC was remarkably rare. Such a striking discordance between beliefs and practices merits further investigation.