Factors associated with timely referral of cancer patients for palliative care services at Chris Hani Baragwanath Academic Hospital, Johannesburg

Abstract

Background: In a South African context, palliative care (PC) is defined as a holistic approach to care and support for patients and their families facing life-threatening illnesses. Referral of cancer patients to PC tends to happen late, especially when the disease has progressed significantly due to various referral factors, with 14%-30% being the prevalence of timely referrals to PC. This study aims to investigate factors associated with timely referrals of cancer patients to PC services at CHBAH, August 2021 – July 2022. The main objective is to determine the prevalence of timely referrals. Method: A retrospective cross sectional study design and secondary data analysis were used to address the aim and objectives. STATA SE version 17 was used to conduct statistical analyses to determine the prevalence of timely referrals. The trend in referral time from diagnosis to PC for cancer patients was assessed using Kaplan-Meier survival analysis. This analysis was stratified by sex, referral place, cancer type, and healthcare provider. Significant differences between groups were evaluated using the log-rank test. Referral times within 90 days of diagnosis were categorized as "timely referral" while those occurring after 90 days were considered "no timely referral" Logistic regression analysis was performed to identify the influence of sociodemographic and clinical factors on the likelihood of a timely referral. Results: The probability of a cancer patient not being referred decreased steadily over the study period; of the 459 patient records that were analyzed, only 63 (13.7%) cancer patients were timely referred to PC. Forty-four (44) (69.8%) of patients who were timely referred to palliative care were from CHBAH wards as opposed to 21(30,2%) those referred timely from the 3 places of referral. The results from this category were significant, with a p-value <0.01. The log-rank test indicates vi that the time it takes for a patient to be referred significantly depends on the place of referral (p- value < 0.01), and this is supported by the logistic regression results. Further, the odds of referring cancer patients with stage 4 cancer to PC are 1.49 times (OR:2.49, 95%CI (1.01-6.17)) more likely than of Stage 1& 2 cancer patients in the adjusted model. This indicates that stage 4 cancer patients are more likely to be referred to palliative care than stage 1 cancer patients. In the unadjusted model, lung cancer patients are 1.81 times (OR:2.81, 95%CI (1.03-7.60)) more likely to be referred to PC compared to breast cancer patients. Conclusion: Healthcare providers play an important role in aiding timely referrals. PC knowledge and acceptability from healthcare providers can exert a positive impact on increasing the number of cancer patients referred timely. This study contributes to the body of knowledge relating to PC and provides insights into significant factors for referring cancer patients to PC services. CHBAH must prioritize and institutionalize referral guidelines that encourage timely referrals to PC to ensure that cancer patients receive timely access to PC.