Criteria for palliative care referral in oncology practice: An instrument development

Introduction: Cancer patients experience significant physical symptoms and psychosocial problems during cancer treatment that negatively impact on quality of life which can be intervened by palliative care. However, the referral of cancer patients to palliative care is still low. Therefore, this study aimed to explore the need of palliative care among doctors working in oncology in order to develop an instrument of criteria for palliative care referral in oncology practice. Methods: A mixed method research with a sequential variant exploratory, quantitative dominant design was used. Using phenomenology orientation, the qualitative study exploring the needs of palliative care referral was conducted and data were obtained through in-depth interviews with 32 oncologic care doctors. Identified dimensions, criteria, sub-criteria and indicators were then used to develop the instrument. In the quantitative study, validity of the instrument was tested through expert judgement and Aiken's V content-validity coefficient was calculated. Results: The study found that palliative referral criteria consisted of 20 indicators, i.e., 15 medical indicators of the aspects related to disease stage, patient's condition, treatment status, and status of care; and 5 non-medical indicators, included the aspects associated with psychological, social, spiritual, communication and decision making. The validity of the instrument was confirmed through the expert panel, in which the Aiken's V coefficient of all indicators ranged high from 0.825 to 0.975. Conclusion: The instrument of palliative care referral criteria was developed which consist of 20 indicators and had good validity.