Implementing automated prognostic models to inform palliative care: more than just the algorithm

Bange, Erin; Courtright, Katherine R.; Parikh, Ravi B.

doi:10.1136/bmjqs-2021-013510

Cited by 2 publications

(1 citation statement)

References 30 publications

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“…Clinicians, so prompted, could consider their response which may include consideration of activities of palliative care such as review of symptom burden, or discussion of goals and preferences, or it may include a referral to specialist palliative care. A system using electronic prompts needs to be as accompanied by clearly communicated but not overly prescriptive guidance, thus reducing uncertainty whilst not reducing physician agency ( 50 ). An effective trigger-prompt system would be one where clinicians are reminded of palliative care benefits and retain the decision making about how and when those are best enacted.…”

Section: Discussionmentioning

confidence: 99%

The feasibility of triggers for the integration of Standardised, Early Palliative (STEP) Care in advanced cancer: A phase II trial

Collins

Sundararajan

et al. 2022

Front. Oncol.

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Background: While multiple clinical trials have demonstrated benefits of early palliative care for people with cancer, access to these services is frequently very late if at all. Establishing evidence-based, disease-specific 'triggers' or times for the routine integration of early palliative care may address this evidencepractice gap.Aim: To test the feasibility of using defined triggers for the integration of standardised, early palliative (STEP) care across three advanced cancers.Method: Phase II, multi-site, open-label, parallel-arm, randomised trial of usual best practice cancer care +/-STEP Care conducted in four metropolitan tertiary cancer services in Melbourne, Australia in patients with advanced breast, prostate and brain cancer. The primary outcome was the feasibility of using triggers for times of integration of STEP Care, defined as enrolment of at least 30 patients per cancer in 24 months. Triggers were based on hospital admission with metastatic disease (for breast and prostate cancer), or development of disease recurrence (for brain tumour cohort). A mixed method study design was employed to understand issues of feasibility and acceptability underpinning trigger points. Results:The triggers underpinning times for the integration of STEP care were shown to be feasible for brain but not breast or prostate cancers, with enrolment of 49, 6 and 10 patients across the three disease groups respectively. The varied feasibility across these cancer groups suggested some important characteristics of triggers which may aid their utility in future work.Conclusions: Achieving the implementation of early palliative care as a standardized component of quality care for all oncology patients will require further attention to defining triggers. Triggers which are 1) linked to objective Frontiers in Oncology frontiersin.org 01

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Section: Discussionmentioning

confidence: 99%