Referral to Palliative Care Services by Indian Oncologists- A Cross-sectional Mixed Methods Survey

Title: REFERRAL TO PALLIATIVE CARE SERVICES BY INDIAN ONCOLOGISTS - A CROSS-SECTIONAL MIXED METHODS SURVEY

The number of cancer cases have increased globally which seems to be exerting significant strain on populations and health systems at all income levels. Most patients with cancer develop physical and psychological symptoms related to their disease and its subsequent treatment which diminishes their quality of life as well as their caregivers. Palliative care (PC) services can respond well to the needs of patients with respect to advanced cancer treatment in addition to coordinating care at the end of life (EOL). PC services can be used by patients at any stage of cancer treatment yet Indian oncologists tend to refer PC services infrequently and much later (i.e., ≤6 months to death) in the cancer trajectory.

In advanced cancer, PC helps patients to live comfortably with improved quality of life, symptom control, mood elevation, disease understanding, EOL care and survival; even if they cannot be cured. PC services aims to improve the quality of life for patients with advanced cancer in low- and middle-income countries (LMICs). However, studies in high-income countries (HICs) have shown that patients are referred to PC much later in the course of the disease. Various reasons for this pattern of late referrals could include limited availability of PC teams; discomfort among some PC specialists in providing care for patients receiving active cancer treatment ;and stigma about PC among patients, their family members and oncologists. The proposed study is a survey of Indian oncologists to better understand their referral practices and access to PC. The objective of this survey is to understand characteristics, opinions, and practices associated with frequency and timing of palliative care referrals. Results from this survey will help us understand the extent of referrals for PC services to be combined into routine oncology practice in India, an LMIC, and may identify important gaps in current practices.