This study examined determinants of timely referral to specialist palliative care among patients with metastatic cancer in a tertiary public hospital in northern Thailand. Although timely integration of palliative care is recommended in oncology guidelines, referral timing remains highly variable in routine clinical practice, particularly within clinician-initiated consultation-based models. A retrospective cohort study was conducted using electronic medical record data from adult patients with metastatic cancer who received specialist palliative care between January 2022 and May 2025. Timely referral was defined as the first palliative care contact within 8 weeks of metastatic cancer diagnosis. Associations with referral timing were evaluated using multivariable logistic regression models with physician-level cluster-robust standard errors.
A total of 766 patients were included, of whom 333 (43.47%) received timely referral. Older age was associated with higher odds of timely referral [Adjusted odds ratios (aOR) 1.022 per year increase; 95% CI 1.007–1.039]. Compared with gastrointestinal cancers, lung (aOR 1.587; 95% CI 1.056–2.384) and hepatobiliary malignancies (aOR 1.769; 95% CI 1.127–2.777) were more likely to receive timely referral, whereas urban residence was associated with lower odds of timely referral (aOR 0.760; 95% CI 0.592–0.974). Physicians with 10–14 years of experience were less likely to initiate timely referral than those with 5–9 years of experience (aOR 0.389; 95% CI 0.193–0.785). Associations persisted after accounting for physician-level clustering, suggesting that referral timing may reflect not only patient characteristics but also physician-related factors. These findings highlight the gap between guideline recommendations and the real-world implementation of timely palliative care. Embedding structured, needs-based referral approaches within routine oncology workflows may support more timely and equitable integration of specialist palliative care in middle-income healthcare settings.
