When to Refer Patients to Palliative Care: Triggers, Traps, and Timely Referrals

Christina S. Melvin, MS, PHCNS, BC; Lynn Oldham, PhD, BN (Hons), RN


Journal of Hospice and Palliative Nursing. 2009;11(5):291-301. 

In This Article


Late referrals or nonreferrals to palliative care are certainly evident from this research study and from the literature. There are a number of contributing factors to this dilemma, and they have been presented in this article. There are clear initiatives in place in both Australia and the United States to begin to remedy this matter.

Clearly, the findings in this research study support the need for additional formal education in medical and nursing schools in Western Australia and in the United States. While great strides have been made to embed undergraduate nursing courses in palliative care into the curricula in the United States, the same initiative needs to be undertaken in schools of medicine throughout the United States. These same initiatives must be undertaken in both nursing and medical schools in Western Australia.

Australia has taken many positive steps in addressing the need for expanded palliative care services. Through the Department of Health and Ageing, money is currently available to educate general practitioners with an interest in palliative care. Participating general practitioners are paid a salary for this education. Western Australia has also formed the National Palliative Care Program, which is specifically aimed at: addressing the needs of patients and caregivers; increasing access to palliative care medicines in the community; education, training and support of the workforce and research and quality improvement for palliative care services. These are huge strides in promoting palliative care.

The need for physicians specializing in palliative care to educate their colleagues about the benefits of palliative is critical in both countries. A change in the paradigm in EOL care delivery will be realized through education of healthcare professionals. In addition, the public must be informed about palliative care services and that this service is appropriate at any point in the disease process to alleviate distressing symptoms.

The fear of losing control of patients or fear of failing the patient may also be addressed through the education of physicians. One palliative care physician eloquently stated that he was quite happy to do the consultation and leave, without taking over the care, if that is what the referring physician wanted. The turf issue between physicians must be eliminated in order to provide palliative care to a greater number of patients. Ultimately, the patient and family will benefit from greater symptom control, more ability to decide how the final days of their lives are lived, and having a healthier bereavement period for the remaining family members.


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