Certain key characteristics also seem to describe those physicians
who embraced the IPCP program by referring patients to the program
early and often. Interviews with physicians revealed patterns in their referring
experiences and behaviors that cluster by program site, medical
specialty and level of referrals. For instance, a number of high-referring
physicians indicated that they see a disproportionate number of very
sick, older and/or dying patients and therefore may be more comfortable
with the idea of palliative care. High-referring physicians also expressed
a focus on the overall welfare of dying patients rather than on
specialty-specific protocols and regimens. Finally, those physicians
who made high volumes of referrals to the IPCP program seemed to
have fewer “turf” issues around control over patient care than those who
did not. One of these physicians noted this issue and expressed with regret
that his colleagues who most fear the loss of control over patient
care simply did not make referrals to the program and thus were never
able to realize that their fears were unfounded.
Finally, physicians who were late adopters or laggards in adopting
the IPCP program by not making high levels of referrals seem to share
some key characteristics as well. In interviews, several low-referring
physicians discussed their wish to retain complete control over patient
care issues as a barrier to referring to the palliative care program. One
low-referring physician indicates that doctors “generally don’t accurately
communicate with patients and families what the patient’s prognosis
is as they are hesitant to say ‘you may not be around in 6 months’
and will just keep going on with treatment instead.” Another physician
indicated that some of her patients have felt abandoned by her after being
referred, as she is no longer as involved with them once they are accepted
into the program, and that this became a barrier for her.