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Referral-to-death; Duration; Healthcare; Cancer patients; Noncancer patients; Palliative care; End-of-life; Patient care

Introduction

The duration of the journey from the point of referral to the endof- life is a critical facet of healthcare that often remains obscured by the emphasis on early detection, diagnosis, and treatment. While these aspects are undeniably important, the time between the moment a patient is referred for medical care and the inevitable end of their life is equally consequential, if not more so [1]. In this article, we will underscore the significance of comprehending the duration of this journey and delve into the multifaceted factors that influence it, with particular focus on two major patient groups: those battling cancer and those confronting other medical conditions. The duration of referral-to-death is not merely a chronological measure; it carries profound implications for the patients themselves and their families. For individuals facing cancer, an extended period between referral and the end of life might be indicative of a courageous and relentless battle against the disease [2]. It can symbolize the determination, hope, and the relentless pursuit of life. However, on the flip side, a prolonged journey may also entail extensive suffering, both physical and emotional, as well as a protracted struggle with the distressing symptoms and arduous treatments associated with advanced cancer. Consequently, it can be a harrowing experience not just for the patients but also for their families who witness their loved ones enduring pain and distress [3]. Conversely, a short duration from referral to the end of life, especially in the context of cancer, can be indicative of late-stage diagnosis or limited treatment options. This raises profound concerns about missed opportunities for providing the patients with comfort, palliative care, and the emotional support needed during the final stages of their illness. It highlights the pressing need for earlier and more effective interventions, not just in terms of medical treatments but also in ensuring the patient's emotional well-being and quality of life during their remaining time. Factors influencing the duration of referral-todeath are diverse and often interrelated [4,5]. They extend beyond the type or stage of the disease, making this issue more complex than it may seem at first glance. Among cancer patients, these influencing factors include the aggressiveness of the tumor and its responsiveness to treatment. Aggressive forms of cancer may lead to a shorter duration from referral to end-of-life due to the rapid progression of the disease, while less aggressive types may provide patients with more time [6].

The effectiveness of available treatments is another crucial factor. Advances in medical science have provided new hope for many cancer patients, offering extended life expectancies and improved quality of life. However, the effectiveness of these treatments can vary greatly, and this, in turn, impacts the duration of the referral-to-death journey. Moreover, the availability and utilization of palliative care services play an instrumental role in shaping the trajectory of this journey [7 ]. Palliative care aims to enhance the comfort and quality of life of patients living with serious illnesses, focusing on symptom management, pain relief, and emotional support. A lack of access to or underutilization of palliative care services can result in a more prolonged and agonizing experience for patients, regardless of their medical condition.

Noncancer patients also face their unique challenges when it comes to the duration of the referral-to-death journey. Individuals dealing with acute medical conditions may experience shorter referral-to-death periods. These cases often involve sudden and severe illnesses where the focus is on urgent medical interventions rather than an extended period of management [8,9]. Conversely, those with chronic illnesses, regardless of whether they are cancer-related or not, may experience prolonged durations from referral to death. Chronic conditions typically require long-term management, and patients may experience a more extended period of care and support before their final moments. One unifying factor affecting both cancer and noncancer patients are the role of timely and effective communication between healthcare providers, patients, and their families. The quality of communication in healthcare is paramount, particularly during the final stages of a patient's journey [10]. Effective communication significantly impacts decision-making, access to palliative care services, and the overall quality of life during this critical time. When healthcare providers communicate clearly and empathetically with patients and their families, it facilitates informed decision-making. It allows patients to make choices about the level and type of care they wish to receive, including the extent of aggressive treatment and the prioritization of palliative care. Additionally, good communication ensures that patients and families are well-informed about the patient's condition, prognosis, and the various care options available. This information empowers them to make decisions that align with the patient's values and preferences. Effective communication also helps address psychological and emotional needs, reducing confusion, anxiety, and the likelihood of unnecessary or unwanted medical interventions. In conclusion, the duration of the journey from referral to the end-of-life is an integral part of healthcare that deserves more attention and focus. Understanding the factors that influence this duration is essential for providing the best possible care to patients, irrespective of whether they are battling cancer or confronting other medical conditions [11]. By recognizing the significance of this journey, addressing the influencing factors, and improving communication within healthcare, we can strive for more compassionate end-oflife experiences, with a greater emphasis on comfort, dignity, and quality of life. Healthcare systems are pivotal in shaping the duration of the journey from referral to the end-of-life. These systems wield considerable influence in the provision of care, and their readiness to address the unique needs of patients during this critical period is of paramount importance. In this context, the availability of palliative care services, hospice care, and comprehensive end-of-life planning can be instrumental in shaping the patient's experience. However, it is disheartening to note that many healthcare systems worldwide remain underprepared to adequately meet the needs of patients during their final journey [12]. Palliative care services play an integral role in enhancing the quality of life during the referral-to-death duration. They are designed to address the physical, psychological, and emotional needs of patients facing serious illnesses, with a focus on managing symptoms, providing pain relief, and offering psychosocial support. Hospice care, a specialized form of palliative care, is particularly tailored to individuals in the final stages of life, prioritizing comfort, dignity, and relief from suffering. However, the accessibility and integration of these services into standard healthcare practice vary greatly from one region to another. In some areas, palliative care is a well-established and integrated component of the healthcare system, providing patients with a seamless transition from curative treatment to end-of-life care. In contrast, in other regions, palliative care services may be underfunded, fragmented, or inadequately staffed, resulting in patients being denied the full benefits of these critical services.

End-of-life planning is another vital aspect that healthcare systems need to address. This planning involves discussions about the patient's preferences, advance directives, and the establishment of clear care goals. It not only facilitates a patient's ability to make informed decisions but also ensures that these decisions are respected and followed during their final journey. Unfortunately, such conversations and planning may be deferred or avoided within the healthcare system, leaving patients and their families unprepared and uninformed [13]. Addressing the deficiencies in healthcare systems regarding the duration of referralto- death is a moral imperative. This involves a concerted effort on the part of healthcare providers, policymakers, and society as a whole. To enhance the patient's experience and ensure that they receive the care and support they deserve, several key steps should be taken:

Invest in palliative care services: Healthcare systems should prioritize funding, staffing, and training for palliative care services. This involves ensuring that palliative care is accessible not only in hospital settings but also in homes and long-term care facilities.

Education and training: Healthcare professionals should receive training in communication skills, symptom management, and end-oflife care. This training will empower them to provide the best possible care and support for patients during their final journey.

Promote early discussions: Initiatives to encourage early discussions about end-of-life care preferences should be introduced. Patients should be encouraged to express their wishes and providers should respect and adhere to those preferences [14,15].

Integration into standard practice: Palliative care should be seamlessly integrated into standard medical practice. It should be considered a fundamental component of healthcare rather than an optional add-on.

s Raise public awareness: Society as a whole should become more informed about the importance of end-of-life planning and palliative care. This can help reduce stigma and encourage open conversations about this critical phase of life.

Conclusion

In conclusion, the duration of the journey from referral to the endof- life represents an often overlooked but undeniably crucial facet of healthcare. It plays a pivotal role in determining the quality of care and the dignity with which patients navigate the final phases of their lives. This journey is marked by various factors, such as the aggressiveness of the illness, the effectiveness of treatments, and, significantly, the preparedness and responsiveness of healthcare systems. Understanding and addressing this duration is a fundamental step towards achieving patient-centered care. It emphasizes the need to treat patients not merely as medical cases but as individuals with unique needs and preferences, especially when they are most vulnerable. Whether patients are dealing with cancer or noncancer conditions, the factors influencing this duration should be the compass guiding our collective efforts to improve healthcare. The central theme here is compassion. By placing greater emphasis on compassionate care and focusing on the final chapters of a patient's life, we can transform the healthcare experience. This transformation involves enhancing communication between healthcare providers, patients, and their families, fostering early discussions about end-of-life care preferences, and normalizing palliative care services as an integral part of healthcare. Furthermore, it necessitates the overhaul of healthcare systems, making them more compassionate, responsive, and prepared to meet the unique needs of patients during their final journey. Our collective responsibility as a society is to embrace this challenge. The shift towards a more compassionate end-of-life experience for all patients is not only a medical objective but a deeply human one. It upholds the dignity and comfort of individuals during one of life's most vulnerable and challenging phases. It acknowledges that the quality of care provided during this time reverberates through families and communities, leaving a lasting impact. As we navigate the complexities of modern healthcare, let us not forget the importance of the journey from referral to death. It is a journey where patient-centered care, compassion, and respect should shine brightly, providing solace and dignity to those who need it the most. By recognizing the significance of this journey and dedicating ourselves to improving it, we can ensure that every patient's final chapters are marked by the utmost dignity, comfort, and respect a testament to our shared humanity.

Acknowledgement

Not applicable.

Conflict of interest:

Author declares no conflict of interest.

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