An investigation of general practitioner referrals to palliative care services.

A cross-sectional interview study designed to elicit general practitioners' reasons for referral to palliative care services was conducted. Three groups of general practitioners (GPs) were sampled: frequent referrers, non-referrers and nurse referrers. Fifteen GPs from each group were interviewed. A structured interview was carried out either face-to-face or over the telephone. The results showed significant differences between groups of GPs relating to why they did and did not refer patients to palliative care services. The main difference was that the GPs who frequently referred did so most often for 'nursing support', while those in the non-referring group most commonly mentioned 'symptom control'. Fifty-three per cent of both frequent and non-referring GPs gave 'the carers coping well' as the commonest reason for not referring patients. Significant differences were also shown in what the GPs perceived was the most important thing they could offer cancer patients, with 60% of the GPs who had referred no patients answering 'my time'. The results also provided evidence that the majority of the GPs characterised a 'good death' as being 'pain free', and that they perceived themselves to have an important role in providing palliative care for their terminally ill patients.