Table 5 Cost–benefit of palliative care referral

Immediate direct benefits of palliative care referral

We call the palliative team because they are much better at doing things like pain control than we are, so we utilise their expertise over there. We do that quite a lot especially in sarcomas when there is complex pain that we find difficult to control (P 007)

It was so nice to see that difference because first three weeks, there was no interaction. Just nothing. Later she just opened up so much and family was happy. I am not saying happy would be the right word, but they were more accepting of the things, which I thought was really good (P 004)

“Palliative team has made an effort to, you know, to be with them during the end of life, after the child has passed away, they have been with the parents. And they have made an environment which was very conducive for both parent and the child” (P 016)

When we decided that the child is progressing on second line chemotherapy. They saw the palliative care team. Finally, the patient died at home, the parents actually phoned and said the child died, but you did everything, and palliative care did everything and thanked us. I think that is one of the things which was really the highlight as all these patients didn’t die in the hospital. They died at home. (P 001)

Long-term benefits of palliative care referral

It gives the chance of sharing the responsibility (…) Instead of you being the sole physician in charge, you get somebody else who will also be their doctor. It always helps to share responsibility, especially when things are not going well. (P 021)

And when you struggle to take care of your normal patients, curative patients, or patient without symptoms, how would you spend time and resources for patients who need end of life care or symptom control. (P 017)

I feel I have become more empathetic (…) I feel I have become much calmer as a person and It’s more of a positive effect. (P 003)

I’m able to forecast and able to predict and able to pre-empt. So that is the skill that I’ve learned by engaging with palliative care physicians. (P 010)

Unintended cost of making a palliative care referral

I remain sceptical about the role of palliative during the curative setting because the worry is that Morphine is interfering with the ability to detect symptoms so that this abdominal pain could be a complication. And I don’t know if the child is getting worse, or there’s going to be respiratory depression and then the child will die because of that. (P 011)

If you go and give information to family about a cancer and the cure rate and the relapse rate and something else, and the palliative care person team goes and completely paint a different picture, they may not be wrong. It’s just how you give the message. So, in a multi-disciplinary set up, the message has to be given consistently the same way. (P 019)

If patients have to shell out more money because they have to see them, that becomes a deterrent. If that is built into the whole oncology costs, like if everything is paid for that includes palliative care team the patients don’t feel that they have to pay separately. (P 021)