Showing papers on "Referral published in 2009"

Textbook of family medicine

Abstract: PART I: BASIC PRINCIPLES 1. The Origins of Family Madicine 2. Principles of Family Medicine 3. Illness in the Community 4. A Profile of Family Pratice 5. Philosophical and Scientific Foundations of Family Medicine 6. Illness, Suffering, and Healing 7. Doctor-Patient Communication 8. Clinical Method 9. The Enhancement of Health and the Prevention of Disease 10. The Family in Health and Disease PART II: CLINICAL PROBLEMS 11. Acute Sore Throat 12. Headache 13. Fatigue 14. Hypertension 15. Diabetes PART III: THE PRACTICE OF FAMILY MEDICINE 16. Home Care 17. Consultation and Referral 19. The Health Profession 20. The Community Service Network 21. Alternative (Complementary) Medicine 22. Practice Management PART IV: EDUCATION AND RESEARCH 23. Continuing Self-Education 24. Research in Family Practice

Physician Referral for Fertility Preservation in Oncology Patients: A National Study of Practice Behaviors

Abstract: Purpose Cancer survival rates are improving, and the focus is moving toward quality survival. Fertility is a key aspect of quality of life for cancer patients of childbearing age. Although cancer treatment may impair fertility, some patients may benefit from referral to a specialist before treatment. However, the majority of studies examining patient recall of discussion and referral for fertility preservation (FP) show that less than half receive this information. This study examined the referral practices of oncologists in the United States. Methods This study examined oncologists' referral practice patterns for FP among US physicians using the American Medical Association Physician Masterfile database. A 53-item survey was administered via mail and Internet to a stratified random sample of US physicians. Results Forty-seven percent of respondents routinely refer cancer patients of childbearing age to a reproductive endocrinologist. Referrals were more likely among female physicians (P = .004), those wi...

Supportive versus palliative care: What's in a name?

Abstract: BACKGROUND: Palliative care has been progressively adopted by American cancer centers; however, referrals to palliative care continue to occur late in the trajectory of illness. It was hypothesized that the perceived association between the name palliative care and hospice was a barrier to early patients' referral. The objectives of this study were to determine the perception of the impact of the name palliative care compared with supportive care on patient referral and to determine whether there was an association between demographic factors and the perceptions of the 2 names by medical oncologists and their midlevel providers (advance practice nurses and physician assistants) at a comprehensive cancer center. METHODS: A survey was conducted among a random sample of 100 medical oncologists and 100 midlevel providers from The University of Texas M. D. Anderson Cancer Center. Information was collected on demographics, previous experience in palliative care, and attitudes and beliefs toward the impact of the name palliative care compared with supportive care on patient referral. RESULTS: A total of 140 of 200 (70%) participants responded (74 midlevel providers and 66 medical oncologists). Median age was 43 years (range, 34.5-50 years), and there were 83 (60%) women. Midlevel providers and medical oncologists generally agreed in their responses to most of the items. More participants preferred the name supportive care (80, 57%) compared with palliative care (27, 19% P .99). CONCLUSIONS: The name palliative care was perceived by medical oncologists and midlevel providers as more distressing and reducing hope to patients and families. Medical oncologists and midlevel providers significantly prefer the name supportive care and stated more likelihood to refer patients on active primary and advanced cancer treatments to a service named supportive care. Cancer 2009. © 2009 American Cancer Society.

Affordability, availability and acceptability barriers to health care for the chronically ill: Longitudinal case studies from South Africa

Abstract: There is an increasing burden of chronic illness in low and middle income countries, driven by TB/HIV, as well as non-communicable diseases. Few health systems are organized to meet the needs of chronically ill patients, and patients' perspectives on the difficulties of accessing care need to be better understood, particularly in poor resourced settings, to achieve this end. This paper describes the experience of poor households attempting to access chronic care in a rural area of South Africa. A household survey (n = 1446 individuals) was combined with qualitative longitudinal research that followed 30 case study households over 10 months. Illness narratives and diaries provided descriptive textual data of household interactions with the health system. In the survey 74% of reported health problems were 'chronic', 48% of which had no treatment action taken in the previous month. Amongst the case study households, of the 34 cases of chronic illness, only 21 (62%) cases had an allopathic diagnosis and only 12 (35%) were receiving regular treatment. Livelihoods exhausted from previous illness and death, low income, and limited social networks, prevented consultation with monthly expenditure for repeated consultations as high as 60% of income. Interrupted drug supplies, insufficient clinical services at the clinic level necessitating referral, and a lack of ambulances further hampered access to care. Poor provider-patient interaction led to inadequate understanding of illness, inappropriate treatment action, 'healer shopping', and at times a break down in cooperation, with the patient 'giving up' on the public health system. However, productive patient-provider interactions not only facilitated appropriate treatment action but enabled patients to justify their need for financial assistance to family and neighbours, and so access care. In addition, patients and their families with understanding of a disease became a community resource drawn on to assist others. In strengthening the public sector it is important not only to improve drug supply chains, ambulance services, referral systems and clinical capacity at public clinics, and to address the financial constraints faced by the socially disadvantaged, but also to think through how providers can engage with patients in a way that strengthens the therapeutic alliance.

Stepped-care prevention of anxiety and depression in late life: a randomized controlled trial.

Abstract: Context Given the public health significance of late-life depression and anxiety, and the limited capacity of treatment, there is an urgent need to develop effective strategies to prevent these disorders. Objective To determine the effectiveness of an indicated stepped-care prevention program for depression and anxiety disorders in the elderly. Design Randomized controlled trial with recruitment between October 1, 2004, and October 1, 2005. Setting Thirty-three primary care practices in the northwestern part of the Netherlands. Participants A total of 170 consenting individuals, 75 years and older, with subthreshold symptom levels of depression or anxiety who did not meet the full diagnostic criteria for the disorders. Intervention Participants were randomly assigned to a preventive stepped-care program (n = 86) or to usual care (n = 84). Stepped-care participants sequentially received a watchful waiting approach, cognitive behavior therapy–based bibliotherapy, cognitive behavior therapy–based problem-solving treatment, and referral to primary care for medication, if required. Main Outcome Measures The cumulative incidence of DSM-IV major depressive disorder or anxiety disorder after 12 months as measured using the Mini International Neuropsychiatric Interview. Results The intervention halved the 12-month incidence of depressive and anxiety disorders, from 0.24 (20 of 84) in the usual care group to 0.12 (10 of 86) in the stepped-care group (relative risk, 0.49; 95% confidence interval, 0.24 to 0.98). Conclusions Indicated stepped-care prevention of depression and anxiety in elderly individuals is effective in reducing the risk of onset of these disorders and is valuable as seen from the public health perspective. Trial Registration isrctn.org Identifier:ISRCTN26474556.

The Descriptive Tyranny of the Common Assessment Framework: Technologies of Categorization and Professional Practice in Child Welfare

Abstract: The Common Assessment Framework is a standard assessment tool to be used by all professionals working with children for assessment and referral. The CAF is hailed as a needs-led, evidence-based tool which will promote uniformity, ensure appropriate ‘early intervention’, reduce referral rates to local authority children's services and lead to the evolution of ‘a common language’ amongst child welfare professionals. This paper presents findings from a study, funded under the Economic and Social Research Council's e-Society Programme. Our purpose in is not primarily evaluative, rather we illustrate the impacts of CAF as a technology on the everyday professional practices in child welfare. We analyse the descriptive, stylistic and interpretive demands it places on practitioners in child welfare and argue that practitioners make strategic and moral decisions about whether and when to complete a CAF and how to do so. These are based on assessments of their accountabilities, their level of child welfare competence and their domain-specific knowledge, moral judgements and the institutional contexts in which these are played out.

The teaching of a structured tool improves the clarity and content of interprofessional clinical communication

Abstract: INTRODUCTION: Suboptimal communication between health professionals has been recognised as a significant causative factor in incidents compromising patient safety. The use of a structured method of communication has been suggested to improve the quality of information exchange. The aim of this study was to determine if the teaching of a communication tool, ISBAR (Identify, Situation, Background, Assessment, Recommendation), a modification of SBAR (Situation, Background, Assessment, Recommendation), improved the content and clarity of a telephone referral in an immersive simulated clinical scenario conducted in real time. METHOD: Seventeen teams of final-year medical students were randomised into two groups. The intervention group participated in a 40 min education session about the ISBAR communication tool. A control group received no training. Each team of five students participated in a simulated clinical scenario using a patient simulator in a mocked-up clinical environment. During each scenario, one student made a telephone referral seeking assistance from a senior colleague. Audio data for the telephone referrals (n = 17 students) were captured during the scenario for both groups. During a blinded review of the data, communication was scored on both content and clarity. RESULTS: Communication content was higher from a mean score of 10.2 to 17.4 items (p<0.001) with the intervention. Clarity of the delivery of information on a 5-point scale was also higher in the intervention group (rho = 0.903, p<0.001). CONCLUSIONS: The teaching of a structured method of communication improved the communication during telephone referral in a simulated clinical setting. This research has implications for how healthcare professionals are taught to communicate with each other.

The future of psychiatry in low- and middle-income countries

Abstract: The great shortage, and inequitable distribution, of psychiatrists in low- and middle-income countries is one of the key reasons for the large treatment gap for people with mental disorders. Psychiatrists need to play a public mental health leadership role in increasing the coverage of mental health care through task shifting of effective interventions to non-specialist health workers. Psychiatrists' new roles should include designing and managing such programmes, building clinical capacity, supervision and quality assurance, providing referral pathways and research.

Depression and Coronary Heart Disease: Recommendations for Screening, Referral, and Treatment

Abstract: Depression is commonly present in patients with coronary heart disease (CHD) and is independently associated with increased cardiovascular morbidity and mortality. Screening tests for depressive symptoms should be applied to identify patients who may require further assessment and treatment. This multispecialty consensus document reviews the evidence linking depression with CHD and provides recommendations for healthcare providers for the assessment, referral, and treatment of depression. (Reprinted with permission from Circulation 2008; 118:1768–1775. © 2008 American Heart Association Inc.)

Primary care and dementia: 1. diagnosis, screening and disclosure

Abstract: Objectives To write a narrative review of the roles of primary care practitioners in caring for people with dementia in the community.Methods The systematic review carried out for the NICE/SCIE Guidelines was updated from January 2006, Cochrane Reviews were identified, and other publications found by consultation with experts.Results The insidious and very variable development of dementia syndromes makes recognition of the syndrome problematic in primary care. Dementia is probably under-diagnosed and under treated with an estimated 50% of primary care patients over 65 not diagnosed by their primary care physicians. This problem of under-diagnosis is probably not due to lack of diagnostic skills, but rather to the interaction of case-complexity, pressure on time and the negative effects of reimbursement systems. Primary care physicians often over-estimate the prevalence of dementia syndromes, but in some countries may also overestimate the prevalence of vascular dementia compared with Alzheimer's disease. Diagnosis is a step-wise process which can be aided by use of a cognitive function test, of which there are a number suitable for primary care use. Evidence based practice protocols can enhance detection rates in primary care, and there is growing evidence that communication skills in talking to people with dementia about dementia can be improved. Nevertheless there are multiple obstacles to bringing recognition forward in time, both in public awareness and professional understanding of the early changes in dementia.Conclusions There is insufficient evidence of benefit to justify population screening in primary care but earlier recognition of people with dementia syndrome is possible within primary care. The diagnosis of dementia is a shared responsibility between generalist and specialist disciplines. Primary care physicians should explore patients' ideas and concerns around their symptoms prior to referral and tentatively discuss possible diagnoses. Once the diagnosis has been confirmed, the primary care physician should provide both practical and emotional support to allow the patient and their family to come to terms with living with dementia, and refer them for additional psychosocial support if required. Copyright (C) 2009 John Wiley & Sons, Ltd.

Underdiagnosis and Referral Bias of Autism in Ethnic Minorities

Abstract: This study examined (1) the distribution of ethnic minorities among children referred to autism institutions and (2) referral bias in pediatric assessment of autism in ethnic minorities. It showed that compared to the known community prevalence, ethnic minorities were under-represented among 712 children referred to autism institutions. In addition, pediatricians (n = 81) more often referred to autism when judging clinical vignettes of European majority cases (Dutch) than vignettes including non-European minority cases (Moroccan or Turkish). However, when asked explicitly for ratings of the probability of autism, the effect of ethnic background on autism diagnosis disappeared. We conclude that the use of structured ratings may decrease the likelihood of ethnic bias in diagnostic decisions of autism.

Diagnostic Spirometry in Primary Care Proposed standards for general practice compliant with American Thoracic Society and European Respiratory Society recommendations A General Practice Airways Group (GPIAG) 1 document, in association with the Association for Respiratory Technology & Physiology (ARTP) 2 and Education for Health 3

Abstract: c Independent specialist respiratory nurse and freelance medical writer; # For and on behalf of: Education for Health, The Athenaeum, 10 Church St, Warwick, UK d Consultant Clinical Scientist; † For and on behalf of: ARTP, Suite 4, Sovereign House, Gate Lane, Boldmere, Sutton Coldfield, UK e Abstract Primary care spirometry services can be provided by trained primary care staff, peripatetic specialist services, or through referral to hospital-based or laboratory spirometry. The first of these options is the focus of this Standards Document. It aims to provide detailed information for clinicians, managers and healthcare commissioners on the key areas of quality required for diagnostic spirometry in primary care - including training requirements and quality assurance. These proposals and recommendations are designed to raise the standard of spirometry and respiratory diagnosis in primary care and to provide the impetus for debate, improvement and maintenance of quality for diagnostic (rather than screening) spirometry performed in primary care. This document should therefore challenge current performance and should constitute an aspirational guide for delivery of this service.

Women`s use of complementary and alternative medicine during pregnancy: a critical review of the literature

Abstract: Background: The use of complementary and alternative medicine has attracted much attention and debate in recent years. The objective of this critical review is to examine the evidence base on use of complementary products and therapies during pregnancy. It examines an important but neglected issue in maternity care. Methods: A database search was conducted in MEDLINE, CINAHL, AMED, and Maternity and Infant Care. A total of 24 papers published between 1999 and 2008 met the selection criteria and were included in the review. Results: Findings of these 24 papers were extracted and reported under four themes: "user prevalence and profile," "motivation and condition of use," "perception and self-reported evaluation," and "referral and information sources." Conclusions: This review highlights four research gaps in the literature, a lack of: large representative samples; in-depth understanding of user experiences and risk perceptions; research comparing consumption patterns across cultures and over time; and work exploring the nature of the therapeutic encounter with complementary practitioners in this area of women's health care.

Assessment, management, and prevention of early childhood caries.

Abstract: Purpose: To discuss the role of primary care health providers in identifying infants and young children at risk for dental caries during well-child visits, in providing anticipatory guidance to parents and primary care givers of at-risk children, and in providing appropriate referrals for the timely establishment of a dental home. Data sources: The search included the following: Ovid MEDLINE, PubMed, American Academy of Pediatrics Web site, American Academy of Pediatric Dentistry Web site, and the American Dental Association Web site. The following search terms were used: dental caries prevention, caries process, caries balance, dental home, early childhood caries, oral health disparities, dental caries risk assessment, fluoride varnish, oral health anticipatory guidance. Search was limited to English language sources from 1990 through 2007. Conclusions: Dental caries is a preventable and reversible infectious disease process, yet it continues to be the single most common chronic disease of childhood. Despite a decrease in caries prevalence and a decrease in untreated tooth decay in 6–19-year-olds in the United States, a 15.2% increase in disease was noted among the nation’s youngest children aged 2–5 years. Primary care health providers are uniquely positioned to play a significant role in the prevention of dental caries and are encouraged to complete certification courses in caries risk assessment, intervention, education, and referral. Implications for practice: Clinicians need to understand the dental caries process, including the process of enamel demineralization and remineralization, and the factors contributing to caries balance. The importance of early identification and intervention for infants and toddlers at high risk for dental caries and primary care health provider-delivered anticipatory guidance during well-child care visits cannot be overestimated.

Assessing the Value of Diabetes Education

Abstract: Purpose The purpose of this study was to evaluate the impact of diabetes self-management education/training (DSME/T) on financial outcomes (cost of patient care). Methods Commercial and Medicare claims payer-derived datasets were used to assess whether patients who participate in diabetes education are more likely to follow recommendations for care than similar patients who do not participate in diabetes education, and if claims of patients who participate in diabetes education are lower than those of similar patients who do not. Results Patients using diabetes education have lower average costs than patients who do not use diabetes education. Physicians exhibit high variation in their referral rates to diabetes education. Conclusions The collaboration between diabetes educators and physicians yields positive clinical quality and cost savings. The analysis indicates that quality can be improved, and cost reduced, by increasing referral rates to diabetes education among low-referring physicians, specifically among men and people in disadvantaged areas. More needs to be done to inform physicians about ways to increase access to diabetes education for underserved populations.

Not Perfect, but Better: Primary Care Providers’ Experiences with Electronic Referrals in a Safety Net Health System

Abstract: Background Electronic referrals can improve access to subspecialty care in safety net settings In January 2007, San Francisco General Hospital (SFGH) launched an electronic referral portal that incorporated subspecialist triage, iterative communication with referring providers, and existing electronic health record data to improve access to subspecialty care

Improved access to comprehensive emergency obstetric care and its effect on institutional maternal mortality in rural Mali.

Abstract: OBJECTIVE: To evaluate the effect of a national referral system that aims to reduce maternal mortality rates through improving access to and the quality of emergency obstetric care in rural Mali (sub-Saharan Africa). METHODS: A maternity referral system that included basic and comprehensive emergency obstetric care, transportation to obstetric health services and community cost-sharing schemes was implemented in six rural health districts in Kayes region between December 2002 and November 2005. In an uncontrolled "before and after" study, we recorded all obstetric emergencies, major obstetric interventions and maternal deaths during a 4-year observation period (1 January 2003 to 30 November 2006): the year prior to the intervention (P-1); the year of the intervention (P0), and 1 and 2 years after the intervention (P1 and P2, respectively). The primary outcome was the risk of death among obstetric emergency patients, calculated with crude case fatality rates and crude odds ratios. Analyses were adjusted for confounding variables using logistic regression. FINDINGS: The number of women receiving emergency obstetric care doubled between P-1 and P2, and the rate of major obstetric interventions (mainly Caesarean sections) performed for absolute maternal indications increased from 0.13% in P-1 to 0.46% in P2. In women treated for an obstetric emergency, the risk of death 2 years after implementing the intervention was half the risk recorded before the intervention (odds ratio, OR: 0.48; 95% confidence interval, CI: 0.30-0.76). Maternal mortality rates decreased more among women referred for emergency obstetric care than among those who presented to the district health centre without referral. Nearly half (47.5%) of the reduction in deaths was attributable to fewer deaths from haemorrhage. CONCLUSION: The intervention showed rapid effects due to the availability of major obstetric interventions in district health centres, reduced transport time to such centres for treatment, and reduced financial barriers to care. Our results show that national programmes can be implemented in low-income countries without major external funding and that they can rapidly improve the coverage of obstetric services and significantly reduce the risk of death associated with obstetric complications.

Autism in Saudi Arabia: presentation, clinical correlates and comorbidity.

Abstract: Although autism is a global disorder, relatively little is known about its presentation and occurrence in many developing countries, such as Saudi Arabia. This article describes the reasons for referral and clinical characteristics of a sample of 49 children (37 males and 12 females) diagnosed with an autistic spectrum disorder at a tertiary referral center in Saudi Arabia. The diagnosis of autism was based on DSM-IV criteria supplemented by information obtained from parent and child interviews, rating scales, and examination of school and hospital records. Females were older than males at the time of referral. Eleven patients had a history of seizure disorder and one patient had a chromosome abnormality. Twenty-five patients were taking psychotropic medications and 14 patients were the product of consanguineous marriages. Clinical and research implications of these findings are discussed.

Early Identification of Behavioral and Emotional Problems in Youth: Universal Screening versus Teacher-Referral Identification

Abstract: Universal screening is one strategy to enhance the early identification of behavioral and emotional problems among youth. Although it appears to be effective, it is unclear if universal screening is more or less effective than current teacher referral practices. Thus, the purpose of this study was to compare the effectiveness of a teacher-rated, universal screener and typical teacher-referral methods in identifying youth at risk for emotional and behavioral problems. Results indicated that of the 24 students identified as at-risk by the universal screening measure, only 11 were previously identified through current teacher referral practices — highlighting the potential benefit of universal screening to enhance early identification. Furthermore, results indicated that academic achievement and student engagement outcomes were significantly correlated with at-risk status by identification method. The strengths and limitations of this study, as well as implications for practice, are discussed.

The quality of maternity care services as experienced by women in the Netherlands

Abstract: Maternity care is all care in relation to pregnancy, childbirth and the postpartum period. In the Netherlands maternity care is provided by midwives and general practitioners (GPs) in primary care and midwives and gynecologists in secondary care. To be able to interpret women's experience with the quality of maternity care, it is necessary to take into account their 'care path', that is: their route through the care system. In the Netherlands a new tool is being developed to evaluate the quality of care from the perspective of clients. The tool is called: 'Consumer Quality Index' or CQI and is, within a standardized and systematic framework, tailored to specific health care issues. Within the framework of developing a CQI Maternity Care, data were gathered about the care women in the Netherlands received during pregnancy, childbirth, and the postpartum period. In this paper the quality of maternity care in the Netherlands is presented, as experienced by women at different stages of their care path. A sample of 1,248 pregnant clients of four insurance companies, with their due date in early April 2007, received a postal survey in the third trimester of pregnancy (response 793). Responders to the first questionnaire received a second questionnaire twelve weeks later, on average four weeks after delivery (response 632). Based on care provider and place of birth the 'care path' of the women is described. With factor analysis and reliability analysis five composite measures indicating the quality of treatment by the care provider at different stages of the care path have been constructed. Overall ratings relate to eight different aspects of care, varying from antenatal care by a midwife or GP to care related to neonatal screening. 41.5 percent of respondents remained in primary care throughout pregnancy, labor, birth and the postpartum period, receiving care from a midwife or general practitioner, 31.3% of respondents gave birth at home. The majority of women (58.5%) experienced referral from one care provider to another, i.e. from primary to secondary care or reverse, at least once. All but two percent of women had one or more ultrasound scans during pregnancy. The composite measures for the quality of treatment in different settings and by different care providers showed that women, regardless of parity, were very positive about the quality of the maternity care they received. Quality-of-treatment scores were high: on average 3.75 on a scale ranging from 1 to 4. Overall ratings on a 0 – 10 scale for quality of care during the antenatal period and during labor, birth and the postpartum period were high as well, on average 8.36. The care path of women in maternity care was seldom straight forward. The majority of pregnant women switched from primary to secondary care and back at least once, during pregnancy or during labor and birth or both. The results of the quality measures indicate that the quality of care as experienced by women is high throughout the care system. But with regard to the care during labor and birth the quality of care scores are higher when women know their care provider, when they give birth at home, when they give birth in primary care and when they are assisted by their own midwife.

Selection of intensive care unit admission criteria for patients aged 80 years and over and compliance of emergency and intensive care unit physicians with the selected criteria: An observational, multicenter, prospective study.

Abstract: Objective:To describe intensive care unit referral decisions by emergency room physicians in patients aged ≥80 yrs.Design:Prospective, observational cohort study of patients aged ≥80 yrs who were triaged in the emergency room, using a list of intensive care unit admission criteria selected by emerge

Routine developmental screening implemented in urban primary care settings: more evidence of feasibility and effectiveness.

Abstract: Objectives The purpose of this study was to examine the feasibility and effectiveness of implementation of validated developmental screening by using the Parents' Evaluation of Developmental Status in 2 urban pediatric practices. Design and methods We implemented the Parents' Evaluation of Developmental Status at Boston Children's Hospital Primary Care Center and at Joseph Smith Community Health Center as quality improvement initiatives. Each practice offered screening to all of the patients attending well-child care visits between 6 months and 8 years of age. The implementation process was investigated by using preimplementation and postimplementation surveys and a focus group of pediatric primary care providers. To assess outcomes, such as changes in identification rates and referrals for developmental and behavioral concerns, we reviewed medical charts of all of the 2- and 3-year-olds present at Children's Hospital Primary Care Center well-child care visits in the periods before and after screening implementation. Results Providers found routine screening easier than expected and feasible to conduct in a busy primary care setting. The practice change resulted in screening of 61.6% of eligible children. Compared with same-aged children before screening, after screening was implemented more behavioral concerns were detected in the 2-year-old group, and more children with developmental concerns were identified in the 3-year-old group. Referral rates for additional evaluation increased only for 3-year-olds, although the types of referrals (ie, audiology and early intervention) were consistent as those found before screening started. Conclusions Implementation of validated screening by using the Parents' Evaluation of Developmental Status was feasible in large, urban settings. Effectiveness was demonstrated via chart review documenting an increased rate of identification of developmental and behavioral concerns. Perceived obstacles, such as the time requirement, should not prevent widespread adoption of screening.

Predictors of Referral for Specialized Psychosocial Oncology Care in Patients With Metastatic Cancer: The Contributions of Age, Distress, and Marital Status

Abstract: Purpose This study examines the rate and prediction of referral for specialized psychosocial oncology care in 326 patients with metastatic GI or lung cancer. Patients and Methods Referral information was abstracted from medical records and hospital databases. Patients completed measures of psychosocial and physical distress and functioning. Results Routine referral occurred in 33% of patients, and in 42% and 44%, respectively, of those scoring high on measures of depression (Beck Depression Inventory [BDI]-II ≥ 15) and hopelessness (Beck Hopelessness Scale ≥ 8). Univariate analyses indicated that referral was associated with younger age, unmarried status, living alone, presence of more depressive symptoms, hopelessness, and attachment anxiety, and with less social support, self-esteem, and spiritual well-being (all P < .05). Among the significantly depressed (BDI-II ≥ 15), 100% of those less than 40 years of age, but only 22% of those age 70 years or older were referred. Multivariate analyses indicated th...