Defining patients as palliative: Hospital doctors' versus general practitioners' perceptions

There appears to be a lack of consensus on the classification of individual patients as 'for palliative care', although the extent of this is unknown. General practitioners (GPs) of 213 patients with a palliative diagnosis of lung or colo-rectal cancer were sent a one-page questionnaire to assess information sent by hospital doctors, and to establish the GPs' perception of patients' palliative status. A total of 185 questionnaires were returned (87% response rate). Of those GPs receiving information from the hospital, one in four rated the adequacy as less than positive; 26% reportedly received no information or received it 'too late'. In 20% of cases, GPs did not perceive patients as palliative, although hospital records suggested that they were, and death certificates received later potentially confirmed this. There was, however, no significant difference between GPs allocating a patient to palliative status or not, in terms of the promptness or adequency of information received from the hospital, as rated by the GP. There was a significant difference in survival between patients whom GPs perceived as for palliative care and those they did not ('palliative' patients died, on average, 117 days earlier). Possible explanations of the differing perceptions of patients' palliative status are discussed. The findings have implications for patient care in the community, patients' informed choices, and palliative care research.