Referral timing of in-hospital cancer deaths to palliative care in a Saudi tertiary care hospital

摘要

Introduction: Late referral of advanced cancer patients to palliative care adversely affects their end-of-life care. We conducted this study to determine the referral timing of in-hospital cancer deaths to palliative care in a Saudi tertiary care hospital. Subjects and methods: A retrospective review of cancer referrals to palliative care during a 4-year period who eventually died in-hospital. The effect of different factors on referral timing was studied. Results: From 1567 referrals, 887 (56.6%) were eligible. Referral during the last week of life occurred in 28% of cases. The median survival from the first referral was 19 days (95% CI, 16-22). In multivariate analysis, the survival differed significantly according to the referring specialty and the setting of referral (P = 0.002, and < 0.001; respectively). The survival was shorter for patients referred from the medical, haematology and paediatric oncology specialties and for those referred in the emergency room or while in-patients. Conclusions: Referral of in-hospital cancer deaths to palliative care occurs late in our setting and many patients are referred when death is imminent. The identification of factors related to this late referral attitude may be helpful in future improvement of end-of-life cancer care. Further research is warranted to investigate other reasons that may lead to late referral and to find ways to improve referral timing.