TY - JOUR
T1 - What influences referrals within community palliative care services? A qualitative case study
AU - Walshe, Catherine
AU - Chew-Graham, Carolyn
AU - Todd, Chris
AU - Caress, Ann
PY - 2008/7/1
Y1 - 2008/7/1
N2 - Evidence suggests that the utilisation of community palliative care services varies considerably according to different patient characteristics. Most literature describes this variability, but does not address why such differences exist. Exploring the processes underpinning referral making rather than simply describing the outcomes of referrals may further our understanding of this variability. The aim of this article was to investigate the influences on referral decisions made within community palliative care services. A qualitative case study strategy was adopted, studying three Primary Care Trusts in England, UK. Data collection used multiple methods (interviews, observation and documentary analysis) from multiple perspectives (including general and specialist palliative care professionals, patients, managers and commissioners). Two core influences on the way health care professionals made referral decisions are identified. First, their perception of their own role in providing palliative care; autonomous professionals make independent judgements about referrals, influenced by their expertise, workload, the special nature of palliative care and the relationship they develop with patients. Second, their perception about those to whom they may refer; professionals report needing to know about services to refer to, and then make a complex judgement about the professionals involved and what they could offer the referrer as well as the patient. These findings indicate that many more factors than an assessment of patients' clinical need affect referrals within community palliative care services. It appears that personal, inter-personal and interprofessional factors have the potential to shape referral practices. Practitioners could be more explicit about influences on decision making, and policy makers take account of these complex influences on referrals rather than just mandating change.
AB - Evidence suggests that the utilisation of community palliative care services varies considerably according to different patient characteristics. Most literature describes this variability, but does not address why such differences exist. Exploring the processes underpinning referral making rather than simply describing the outcomes of referrals may further our understanding of this variability. The aim of this article was to investigate the influences on referral decisions made within community palliative care services. A qualitative case study strategy was adopted, studying three Primary Care Trusts in England, UK. Data collection used multiple methods (interviews, observation and documentary analysis) from multiple perspectives (including general and specialist palliative care professionals, patients, managers and commissioners). Two core influences on the way health care professionals made referral decisions are identified. First, their perception of their own role in providing palliative care; autonomous professionals make independent judgements about referrals, influenced by their expertise, workload, the special nature of palliative care and the relationship they develop with patients. Second, their perception about those to whom they may refer; professionals report needing to know about services to refer to, and then make a complex judgement about the professionals involved and what they could offer the referrer as well as the patient. These findings indicate that many more factors than an assessment of patients' clinical need affect referrals within community palliative care services. It appears that personal, inter-personal and interprofessional factors have the potential to shape referral practices. Practitioners could be more explicit about influences on decision making, and policy makers take account of these complex influences on referrals rather than just mandating change.
KW - Case study
KW - Interprofessional care
KW - Palliative care
KW - Primary health care
KW - Referrals
KW - UK
UR - http://www.scopus.com/inward/record.url?scp=44349117287&partnerID=8YFLogxK
U2 - 10.1016/j.socscimed.2008.03.027
DO - 10.1016/j.socscimed.2008.03.027
M3 - Article
C2 - 18433963
AN - SCOPUS:44349117287
VL - 67
SP - 137
EP - 146
JO - Social Science and Medicine
JF - Social Science and Medicine
SN - 0277-9536
IS - 1
ER -