Patient-rated acceptability of automatic palliative care referral: a prospective cohort study.

Abstract

Context: Timely palliative care can alleviate distress after diagnosis of an incurable cancer. However, late referrals to palliative care continue, reflecting various provider and patient barriers.

Objective: To determine patient/caregiver-reported acceptability of a phone call offering a supportive and palliative care (SPC) consultation without requiring oncologist referral.

Methods: Two SPC nurses screened out-patient clinic lists at a tertiary cancer center weekly and called all eligible patients to offer a SPC consultation. Eligibility: >18 years, newly diagnosed/suspected stage IV non-small cell lung cancer and completed first oncologist visit. Patients/caregivers were surveyed about the acceptability of the phone call offering SPC consultation, using Sekhon's Framework of Acceptability domains.

Results: Among 113 patients screened, 81 patients/caregivers were contacted and offered a SPC consultation; 72% accepted the consultation. Of 48 patients/caregivers surveyed, 94% rated overall acceptability of the call somewhat/completely acceptable; 6% rated it neither acceptable nor unacceptable. Within specific acceptability domains, 95% were comfortable receiving the call; 92% understood why they received the call; 87% found the call valuable; 70% found the call helpful; 66% learned about SPC from the call; no one expressed concern that the SPC nurse had access to their contact/health information; 97% thought the call required little physical/emotional effort and were confident in their ability to participate (i.e., to ask questions/make decisions).

Conclusion: These unsolicited phone calls offering SPC consultation were highly acceptable to patients/caregivers, and most agreed to the consultation. Implementing routine calls offering SPC consultation may be a timely alternative to awaiting conventional oncologist referral.