Referral practices of non-physician healthcare professionals in oncology

• Main Author: Chia, Phoebe Si Qi
• Other Authors: Ho Hau Yan Andy
• Format: Final Year Project
• Language: English
• Published: Nanyang Technological University 2020
• Subjects: Social sciences::Psychology
• Online Access: https://hdl.handle.net/10356/138079
• Institution: Nanyang Technological University

Background: Many terminally ill cancer patients in Singapore require palliative care to relieve their suffering. However, the rate of referral to palliative care remains low and late. Additionally, local palliative care guidelines that serve to advise healthcare professionals remain unclear. Despite the fact that a team-based approach is important in catering holistic care for patients, non-physicians’ experiences with referral are not studied. This qualitative study explores the reasons why oncology non-physician healthcare professionals (NPHPs) do not refer cancer patients to palliative care. Methods: A phenomenological method using an interpretivist-constructivist paradigm was used. In-depth interviews were conducted with nurses and medical social workers. A total of 5 transcripts were analysed using thematic analysis. Results: Seven key themes were identified and organized into two major themed categories: System-Based Reason and Belief-Based Reason. Under System-Based Reason, four themes were identified: (1) physicians as main referral point; (2) power difference between healthcare professionals; (3) misalignment of referral criteria; (4) lack of resources. Under Belief-Based Reason, three themes were identified: (1) NPHPs’ misconceptions of palliative care; (2) patients’ misconceptions of palliative care; (3) physicians’ belief in the curative approach. Discussion: By targeting the reasons behind non-referral, we can increase the rate of referral to palliative care, and relieve their suffering. Referral to palliative care is important for terminally ill cancer patients so that they can achieve a good quality of life. In an ideal healthcare system, early referrals should be done in interdisciplinary teams, with active treatment concurrently provided.