What influences referrals within community palliative care services? A qualitative case study

Area of Science:

• Health Services Research
• Palliative Care
• Qualitative Research

Background:

• Community palliative care service utilization varies significantly among patient groups.
• Existing literature often describes this variability but lacks insight into its underlying causes.
• Understanding referral processes is crucial for explaining utilization differences.

Purpose of the Study:

• To investigate the factors influencing referral decisions within community palliative care services.
• To explore the decision-making processes of healthcare professionals regarding palliative care referrals.

Main Methods:

• Qualitative case study design.
• Involved three Primary Care Trusts in England, UK.
• Utilized interviews, observation, and documentary analysis from diverse professional and patient perspectives.

Main Results:

• Two primary influences on referral decisions were identified: professionals' perceptions of their own roles and their understanding of referral services.
• Autonomous professionals' judgments are shaped by expertise, workload, the nature of palliative care, and patient relationships.
• Referral decisions involve complex assessments of available services and the professionals within them, beyond just clinical need.

Conclusions:

• Referral practices in community palliative care are shaped by personal, interpersonal, and interprofessional factors, not solely clinical need.
• Healthcare professionals' decision-making processes are complex and influenced by their roles and knowledge of services.
• Greater transparency in decision-making and consideration of these complex factors by policymakers are recommended.