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Palliative care referral practices and perceptions: The divide between metropolitan and non-metropolitan general practitioners

  • Claire E. Johnson (a1), Afaf Girgis (a1), Christine L. Paul (a1) and David C. Currow (a2)



Late or non-referral of patients to specialist palliative care (SPC) services may affect patients' and their carers' quality of care. General practitioners (GPs) are key professionals in linking people with SPC. The aim of this article is to assess GPs' perceptions and SPC referrals for their patients with advanced cancer and differences between metropolitan (M GPs) and non-metropolitan GPs (NM GPs).


Self-report survey mailed to a stratified random sample of 1,680 Australian GPs was used.


Thirty-one percent (469) of eligible GPs returned surveys. More M GPs than NM GPs reported referring >60% of their patients for SPC (p = 0.014); and that a more comprehensive range of SPC services was available. The most frequently reported referral prompts were: presence of terminal illness (M GPs, 71%, NM GPs, 66%, ns (not significant)); future need for symptom control (69% vs. 59%, ns) and uncontrolled physical symptoms (63% vs. 54%, ns). Reasons for not referring were: doctor's ability to manage symptoms (62% vs. 68%, ns) and the absence of symptoms (29% vs. 18%, p = 0.025). Higher referral was associated with: having a palliative care physician or consultative service available; agreeing that all patients with advanced cancer should be referred, and agreeing that with SPC, the needs of the family are better met.

Significance of results:

Referrals for SPC were primarily disease-related rather than for psychological and emotional concerns. Measures are needed to encourage referrals based upon psychosocial needs as well as for physical concerns, and to support GPs caring for people with advanced cancer in areas with fewer comprehensive SPC services.


Corresponding author

Address correspondence and reprint requests to: Afaf Girgis, Centre for Health Research and Psycho-oncology, The Cancer Council NSW/University of Newcastle and Hunter Medical Research Institute, Locked bag 10, Wallsend NSW 2287, Australia. Email:


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Ajzen, I. (1988). Attitudes, Personality and Behaviour. Milton Keynes. UK: Open University Press.
AMPCo Direct. (2002). AMPCo Medical Masterfile. Unpublished manuscript, Sydney.
Australia Post. (2005). Print Post Sort Plan Guide.
Australian Government Department of Health and Ageing. (2005). General Practice in Australia: 2004. Canberra: Australian Government Department of Health and Ageing.
Brickner, L., Scannell, K., Marquet, S., et al. (2004). Barriers to hospice care and referrals: Survey of physicians' knowledge, attitudes and perceptions in a health maintenance organization. Journal of Palliative Medicine, 7, 411418.
Campbell Research & Consulting. (2006). Community Attitudes Towards Palliative Care. North Fitzroy: Australian Government Department of Health and Ageing.
Commonwealth Department of Health and Aged Care. (2000). General Practice in Australia: 2000. Canberra: Commonwealth Department of Health and Aged Care.
Currow, D.C. & Nightingale, E.M. (2003). “A planning guide”: Developing a consensus document for palliative care service provision. Medical Journal of Australia, 149, S23S25.
Fallowfield, L., Ratcliffe, D., Jenkins, V., et al. (2001). Psychiatric morbidity and its recognition by doctors in patients with cancer. British Journal of Cancer, 84, 10111015.
Friedman, B.T., Harwood, M.K. & Shields, M. (2002). Barriers and enablers to hospice referrals: An expert overview. Journal of Palliative Medicine, 5, 7384.
Hays, R.B., Veitch, P.C., Cheers, B., et al. (1997). Why doctors leave rural practice. Australian Journal of Rural Health, 5, 198203.
Johnson, C., Girgis, A., Paul, C., et al. (2008). Cancer specialists' palliative care referral practices and perceptions: results of a national survey. Palliative Medicine, 22, 5158.
McAvoy, B.R. & Kaner, E.F.S. (1996). General practice postal surveys: A questionnaire too far? British Medical Journal, 313, 732733.
Mitchell, G.K. (2002). How well do general practitioners deliver palliative care? A systematic review. Palliative Medicine, 16, 457464.
Mount Olivet Community Service. (2003). Research Study into the Educational, Training and Support Needs of General Practitioners in Palliative Care. Canberra: Rural Health and Palliative Care Branch, Australian Government Department of Health and Ageing.
Newell, S., Sanson Fisher, R.W., Girgis, A., et al. (1998). How well do medical oncologists' perceptions reflect their patients' reported physical and psychosocial problems? Cancer, 83, 16401651.
Ogle, K.S., Mavis, B. & Wyatt, G.K. (2002). Physicians and hospice care: Attitudes, knowledge, and referrals. Journal of Palliative Medicine, 5, 8590.
Palliative Care Australia. (2005). A Guide to Palliative Care Service Development: A Population Based Approach. Deakin West: Palliative Care Australia.
Quantum Market Research. (2003). Community Attitudes to Palliative Care Issues – Quantitative Report. Canberra: Australian Government Department of Health and Ageing.
SAS Institute. (1999–2001). SAS System for Windows (Version 8). Cary, NC: SAS Institute.
Steinhauser, K.E., Christakis, N.A., Clipp, E.C., et al. (2000). Factors considered important at the end of life by patients, family, physicians and other care providers. Journal of the American Medical Association, 248, 24762482.
Strasser, R., Strasser, R.P., Hays, R.B., et al. (2000). Is Australian rural practice changing? Findings from the National Rural General Practice Study. Australian Journal of Rural Health, 8, 222226.
World Health Organization. (2002). National Cancer Control Programmes: Policies and Managerial Guideline, 2nd ed. Geneva: World Health Organization.



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