Factors influencing the referral of non-cancer patients to community specialist palliative care nurses

Aim: To understand why non-cancer patients are under-represented on the caseloads of community Macmillan specialist palliative care nurses by exploring what influences community health professionals' referral patterns of non-cancer patients in one locality of a primary care trust. Design: The study adopted a qualitative design, making use of semi-structured interviews with a purposive sample of community health professionals comprising three GPs, three district nurses, and three community matrons. The framework approach was used for analysis. Findings: The classification of patients, the perception of the palliative care service, the existence of different pathways of care for cancer and non-cancer patients, and the role of other specialist nurses all seem to influence the referral patterns of community health professionals. Conclusion: Although further research is required to fully understand all of the relevant viewpoints, in particular those of patients and carers, it appears that innovative new models of service delivery could be developed that address the engrained perception of the Macmillan nursing service as being for dying cancer patients only, as well as the blurred boundaries between Macmillan nurses and other senior clinical nurses.