Title: G06-A Early Palliative Care: Attitudes and Opinions of Canadian Palliative Care Physicians
Abstract: Early palliative care (EPC) is increasingly recommended but seldom practised. Our aim was to describe Canadian palliative care physicians’ attitudes and opinions about EPC and to determine factors associated with receiving early referrals. Palliative care physicians identified by the Canadian Society of Palliative Care Physicians were invited to complete a survey evaluating their attitudes and opinions about EPC by mail and email. Logistic regression was performed on a sample of 257 specialized palliative care (SPC) physicians, (receiving referrals from other physicians) to determine factors associated with receiving early referrals. Backwards likelihood ratio was used to select covariates for the multivariate model (entry p 0.2). The response rate was 71% (531/747); 48% were SPC physicians. The majority reported that for cancer (93.9%) and non-cancer (90.2%) patients, referral to palliative care should ideally be early (at prognosis >6 months, upon diagnosis of cancer/life-limiting illness, or upon diagnosis of incurable cancer). Only 20.5% reported the average survival for patients referred to them was >6 months. Having a postgraduate degree (OR 2.5, 95% CI 1.1-5.5); providing care mainly for non-cancer patients (4.0, 1.3-12.3); and female sex (2.7, 1.2-6.2) were associated with receiving early referrals. Those agreeing that patients should have stopped all chemotherapy before palliative care referral (0.34, 0.16-0.73) were less likely to receive early referrals. Although SPC physicians prefer EPC, the majority do not receive referrals early. Potential barriers to receiving early referrals include demographic and attitudinal factors as well as those related to the nature of palliative care practice.