CHARACTERISTICS OF REFERRALS TO AN INPATIENT HOSPICE AND A SURVEY OF GENERAL-PRACTITIONER PERCEPTIONS OF PALLIATIVE CARE

In order to determine symptoms, drug prescribing and physical problems of patients referred to an inpatient hospice, case notes from 130 con secutive first admissions (95 general practitioner (GP) referrals, 35 consultant referrals) were analysed. GP referrals were more likely to be constipated, require care and be discharged to home. Consultant ref errals were more gravely ill, dependent and more likely to die in the hospice. On admission 76 (58%) patients were receiving opiates with co -prescription of opiate and laxative occurring in 41% (31/76) of the c ases. The prescription of laxatives with the symptoms of constipation occurred in 62% (26/42) of the cases on admission. A telephone survey of 79 referring GPs revealed that 37% had attended neither a course no r a lecture relevant to palliative care in the past 3 years. GPs exper ienced difficulties frequently or always in: (a) managing pain (8/79); (b) managing other symptoms (25/79); (c) helping patients and relativ es cope with their emotional distress (18/79); and (d) coping with the ir own emotional responses to death and dying (5/79). In conclusion, t he differences demonstrated between the GP and consultant referrals ha ve implications for purchasers. The high incidence of possible opiate- induced side-effects and the difficulties with symptom control express ed by some GPs indicate a continuing need for effective educational in put.