Using social exchange theory to understand non-terminal palliative care referral practices for Parkinson’s disease patients

Abstract

Background:

A palliative approach is recommended in the care of Parkinson’s disease patients; however, many patients only receive this care in the form of hospice at the end of life. Physician attitudes about palliative care have been shown to influence referrals for patients with chronic disease, and negative physician perceptions may affect early palliative referrals for Parkinson’s disease patients.

Aim:

To use Social Exchange Theory to examine the association between neurologist-perceived costs and benefits of palliative care referral for Parkinson’s disease patients and their reported referral practices.

Design:

A cross-sectional survey study of neurologists.

Setting/participants:

A total of 62 neurologists recruited from the National Parkinson Foundation, the Medical Association of Georgia, and the American Academy of Neurology’s clinician database.

Results:

Participants reported significantly stronger endorsement of the rewards (M = 3.34, SD = 0.37) of palliative care referrals than the costs (M = 2.13, SD = 0.30; t(61) = −16.10, p < 0.0001). A Poisson regression found that perceived costs, perceived rewards, physician type, and the number of complementary clinicians in practice were significant predictors of palliative care referral.

Conclusion:

Physicians may be more likely to refer patients to non-terminal palliative care if (1) they work in interdisciplinary settings and/or (2) previous personal or patient experience with palliative care was positive. They may be less likely to refer if (1) they fear a loss of autonomy in patient care, (2) they are unaware of available programs, and/or (3) they believe they address palliative needs. Initiatives to educate neurologists on the benefits and availability of non-terminal palliative services could improve patient access to this care.

Keywords

Palliative care Parkinson’s disease neurologist social exchange theory referrals

Get full access to this article

View all access options for this article.

References

Langston

JW.

The Parkinson’s complex: parkinsonism is just the tip of the iceberg. Ann Neurol 2006; 59: 591–596.

Lees

Hardy

Revesz

Parkinson’s disease. Lancet Neurol 2009; 373: 2055–2066.

Tolosa

Wenning

Poewe

The diagnosis of Parkinson’s disease. Lancet Neurol 2006; 5(1): 75.

Bunting-Perry

LK.

Palliative care in Parkinson’s disease: implications for neuroscience nursing. J Neurosci Nurs 2006; 38(2): 106–113.

Hudson

Toye

Kristjanson

LJ.

Would people with Parkinson’s disease benefit from palliative care?

Palliat Med 2006; 20(2): 87–94.

National Guideline Clearinghouse. Clinical practice guidelines for quality palliative care. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ), 2009, http://www.nationalconsensusproject.org/Guideline.pdf (accessed 24 November 2013).

Institute of Medicine (ed.) Dying in America. Washington, DC: National Academy Press, 2014.

Morrison

Penrod

Cassel

et al . Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med 2008; 168(16): 1783.

Temel

Greer

Muzikansky

et al . Early palliative care for patients with metastatic non–small-cell lung cancer. N Engl J Med 2010; 363(8): 733–742.

10.

Bestall

Ahmed

Ahmedzai

et al . Access and referral to specialist palliative care: patients’ and professionals’ experiences. Int J Palliat Nurs 2004; 10(8): 381–389.

11.

Cherny

. Stigma associated with “palliative care.” Cancer 2009; 115(9): 1808–1812.

12.

Fadul

Elsayem

Palmer

et al . Supportive versus palliative care: what’s in a name? Cancer 2009; 115(9): 2013–2021.

13.

Rodriguez

Barnato

Arnold

RM.

Perceptions and utilization of palliative care services in acute care hospitals. J Palliat Med 2007; 10(1): 99–110.

14.

Ahluwalia

Fried

TR.

Physician factors associated with outpatient palliative care referral. Palliat Med 2009; 23(7): 608–615.

15.

Sutton

Social-psychological approaches to understanding addictive behaviours: attitude-behaviour and decision-making models. Br J Addict 1987; 82(4): 355–370.

16.

Shortell

SM.

Determinants of physician referral rates: an exchange theory approach. Med Care 1974; 12: 13–31.

17.

Broom

Kirby

Good

et al . Specialists’ experiences and perspectives on the timing of referral to palliative care: a qualitative study. J Palliat Med 2012; 15(11): 1248–1253.

18.

Forrest

Glade

Baker

et al . Coordination of specialty referrals and physician satisfaction with referral care. Arch Pediatr Adolesc Med 2000; 154(5): 499–506.

19.

Kinchen

Cooper

Levine

et al . Referral of patients to specialists: factors affecting choice of specialist by primary care physicians. Ann Fam Med 2004; 2(3): 245–252.

20.

Shaw

Special report: bringing palliative care to neurology. Neurol Today 2010; 10(19): 16.

21.

Shortell

Anderson

OW.

The physician referral process: a theoretical perspective. Health Serv Res 1971; 6(1): 39.

22.

Walshe

Chew-Graham

Todd

et al . What influences referrals within community palliative care services? A qualitative case study. Soc Sci Med 2008; 67(1): 137–146.

23.

Carver

Vickrey

Bernat

et al . End-of-life care: a survey of US neurologists’ attitudes, behavior, and knowledge. Neurology 1999; 53(2): 284–293.

24.

Dalal

Palla

Hui

et al . Association between a name change from palliative to supportive care and the timing of patient referrals at a comprehensive cancer center. Oncologist 2011; 16(1): 105–111.

25.

Prizer

Browner

The integrative care of Parkinson’s disease: a systematic review. J Parkinsons Dis 2012; 2(2): 79–86.

26.

Faul

Erdfelder

Buchner

et al . Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 2009; 41: 1149–1160.

27.

Faul

Erdfelder

Lang

A-G

et al . G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39: 175–191.

28.

Peto

Jenkinson

Fitzpatrick

Determining minimally important differences for the PDQ-39 Parkinson’s disease questionnaire. Age Ageing 2001; 30(4): 299–302.

29.

Bede

Brannagáin

DÓ

Lorenzl

et al . Symptomatic Management and Palliative Care in Neurodegenerative Disease. In: Hardiman

Doherty

(eds) Neuro-degenerative Disorders. London: England: Springer-Verlag London Limited, 2011, pp. 263–289.

30.

Miyasaki

JM.

Palliative care in Parkinson’s disease. Curr Neurol Neurosci 2013; 13(8): 1–4.

31.

Wilcox

SK.

Extending palliative care to patients with Parkinson’s disease. Br J Hosp Med 2010; 71(1): 26–30.

32.

Morrison

Maroney-Galin

Kralovec

et al . The growth of palliative care programs in United States hospitals. J Palliat Med 2005; 8(6): 1127–1134.

33.

Glass

Burgess

A statewide status report on hospital-based palliative care programs. J Palliat Med 2011; 14(7): 806–809.

34.

Meier

Beresford

Outpatient clinics are a new frontier for palliative care. J Palliat Med 2008; 11(6): 823–828.

35.

Johnson

Girgis

Currow

Cancer specialists’ palliative care referral practices and perceptions: results of a national survey. Palliat Med 2008; 22: 51–57.

36.

Jepson

Asch

Hershey

et al . In a mailed physician survey, questionnaire length had a threshold effect on response rate. J Clin Epidemiol 2005; 58: 103–105.

37.

Brickner

Scannell

Marquet

et al . Barriers to hospice care and referrals: survey of physicians’ knowledge, attitudes, and perceptions in a health maintenance organization. J Palliat Med 2004; 7(3): 411–418.