Da. Seamark et al., CHARACTERISTICS OF REFERRALS TO AN INPATIENT HOSPICE AND A SURVEY OF GENERAL-PRACTITIONER PERCEPTIONS OF PALLIATIVE CARE, Journal of the Royal Society of Medicine, 89(2), 1996, pp. 79-84
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.