Referrals to a voluntary sector cancer day care centre: a descriptive study

Perspectives on psychosocial and spiritual cancer support services in New Zealand

In New Zealand, support services have been developed in response to patient need but are variable. The benefits of psycho-social-spiritual care in reducing distress and enhancing quality of life for people with cancer and their families are well established yet unmet needs continue to feature. This project aimed to examine how health care professionals assessed for psycho-social-spiritual distress and unmet need, decisions on appropriate support, and identification of barriers in the referral process. A mixed-methods approach was used for this research. The qualitative phase entailed semistructured interviews with health care professionals working in cancer care. The quantitative phase was an online survey of oncologists and nurses. Thematic analysis was carried out by performing a side-by-side analysis of both sets of data. Nurses were most likely to assess for psycho-social-spiritual need and to refer to support services. Despite a clear mandate to provide regular psycho-social-spiritual assessment, there is no consistency of assessment and referral across New Zealand. There are clearly unmet psycho-social-spiritual needs among people affected by cancer in New Zealand, with health care professionals in this study noting structural impediments to adequate supportive care. There is a mismatch between the importance placed on such care and the capacity that is currently available. The results of this study provide evidence that can be used to argue for improvements in the infrastructure, funding allocation and policy that would allow for better psycho-social-spiritual care within the challenging context of increasing numbers of those affected by cancer.

Why do health professionals refer individual patients to specialist day hospice care?

BACKGROUND

There are no nationally agreed criteria for admission to specialist palliative day care (SPDC). Previous work has called for future research to qualitatively examine why health and social professionals make referrals to day care. Therefore the current study aims to address this question using semistructured interviews to gain first hand accounts of referrers' reasons for making referrals to SPDC.

DESIGN AND METHOD

The reasons for referral to SPDC of eight professionals were explored using semistructured interviews. An exploratory methodology (interpretative phenomenological analysis [IPA]) was used to analyze the data to allow for an in-depth investigation.

RESULTS

Six main themes were apparent with regard to referring a patient to SPDC: physical, social and psychological well-being, continuity of care, introduction to the hospice environment, and caregiver respite.

CONCLUSIONS

This study provides an insight into reasons for referral to SPDC. Referrers value the multiprofessional team, the holistic approach to care as useful to managing difficult, complex, and persistent problems in patients wishing to be cared for in the community. Additional benefits include a helpful introduction to hospice services and much needed regular respite for caregivers. Future research into patient and professional perceptions of the process of referral to SPDC could be useful. Expansion of the current study could contribute to the development of a standardized referral tool to be used in conjunction with referrers' clinical judgment.