Palliative Care in the Outpatient Oncology Setting: Evaluation of a Practical Set of Referral Criteria

Glare, Paul; Semple, Deborah; Stabler, Stacy M.; Saltz, Leonard B.

doi:10.1200/jop.2011.000367

Cited by 70 publications

(66 citation statements)

References 19 publications

(18 reference statements)

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“…Two preliminary studies of the feasibility of implementing the NCCN screening and referral guidelines in gastrointestinal oncology outpatient or inpatient settings showed that, as expected, a substantial proportion of patients had palliative care needs. 36,37 Although it was possible to rapidly screen patients for palliative care needs (fewer than 5 minutes per patient), screening could add substantially to the nursing workload in a busy clinic. 36,37 Furthermore, the proportion of patients who meet the NCCN criteria for referral to palliative care consultations could present resourcing challenges if those criteria are routinely implemented in clinical practice.…”

Section: Data From Other Randomized Clinical Trialsmentioning

confidence: 99%

“…36,37 Although it was possible to rapidly screen patients for palliative care needs (fewer than 5 minutes per patient), screening could add substantially to the nursing workload in a busy clinic. 36,37 Furthermore, the proportion of patients who meet the NCCN criteria for referral to palliative care consultations could present resourcing challenges if those criteria are routinely implemented in clinical practice. 36 …”

Section: Data From Other Randomized Clinical Trialsmentioning

confidence: 99%

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Early Implementation of Palliative Care Can Improve Patient Outcomes

Glare

2013

J Natl Compr Canc Netw

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Patients with cancer experience many complex issues throughout the trajectory of the disease. These range from the physical consequences of cancer and treatment to the psychological, social, and spiritual issues associated with living with the disease. An individualized, comprehensive, and interdisciplinary approach is needed to reduce patient suffering and ensure appropriate symptom management and support from the time of first diagnosis to end of life. Data from randomized clinical trials prove that patients provided with early palliative care can experience relief of symptoms and improvements in quality of life, mood, satisfaction, resource use, and advanced care planning. Professional organizations such as ASCO have begun to develop recommendations that integrate palliative care into standard oncologic care from the time a person is diagnosed with metastatic or advanced cancer. NCCN has a palliative care guideline that recommends early and ongoing assessment of palliative care needs and referral to specialist palliative care services in more complex cases. In turn, oncologists need to consider how best to screen patients and integrate early palliative care with routine oncologic care, within the context of their busy clinics, to ensure that patients, families, and caregivers receive timely support. (JNCCN 2013;11(Suppl 1): S3-S9)

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Section: Data From Other Randomized Clinical Trialsmentioning

confidence: 99%

Section: Data From Other Randomized Clinical Trialsmentioning

confidence: 99%

Early Implementation of Palliative Care Can Improve Patient Outcomes

Glare

2013

J Natl Compr Canc Netw

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“…We used tools for subjective self-assessment of symptoms and psychological problems [24][25][26] as well as a screening tool for palliative care needs assessed by professional caregivers [27] to include the patients' and the professionals' views. Long-term aim realized by a following larger study will be the development and validation of a short screening instrument indicating palliative care need in patients with chronic heart failure in daily clinical routine.…”

Section: Study Aimsmentioning

confidence: 99%

“…Screening for palliative care need: A modified version of the "FiveItem Palliative Care Screening Tool" developed by Glare et al was used to screen for potential palliative care need by the treating cardiologists [27,33]. The "Five-Item Palliative Care Screening Tool" was developed to screen advanced cancer patients for their potential palliative care need.…”

Section: Measurementsmentioning

confidence: 99%

Self-assessment and Screening for Palliative Care Need in Patients with Chronic Heart Failure

Ehlert¹,

Kodolitsch²,

Ullrich³

et al. 2017

J Palliat Care Med

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Objective: Patients with chronic heart failure (CHF) rarely receive palliative care today. Methods:In a cross-sectional pilot study we evaluated feasibility of self-assessment and physician-directed screening for palliative care need in CHF patients. Patients answered German versions of the "Minimal Documentation system for patients in palliative care" (MIDOS), "Distress-Thermometer" (DT), and the "Patient Health Questionnaire" (PHQ4). A modified version of the "Five-Item Palliative Care Screening Tool" was used to screen for palliative care need by the treating cardiologists.Results: 218 patients were asked to participate and 148 (67%) completed all questionnaires. Median symptom burden (MIDOS) was 7 out of 30 points (SD 4.868), overall wellbeing was two of 5 (SD 0.902), and median distress score was 6 of 10 (SD 2.318). Most frequent moderate or severe symptoms were dyspnea (52%), weakness (51%), and tiredness (49%). Significant distress (DT score>5) was indicated by 106 patients (72%). Exhaustion (79%), sleeping problems (75%), and problems with breathing (69%) were most frequent problems. Only 11% and 14% of patients presented with significant anxiety and depression, respectively (PHQ4-score>3).Palliative care need was scored with mean 6.8 out of 12 points (SD 2.223). Using a cut-off value of >5, 113 patients (76%) would have needed palliative care. Objective parameters for palliative care need (symptom burden 43%, distress 68%, decision-making 67%) were indicated, but request for palliative care by the patients, their relatives (5%) or the cardiology team (5%) was rare. Symptom burden and palliative care screening showed significant, but not clinically relevant interaction. Conclusion:This pilot study, feasibility of palliative care self-assessment and the modified screening instrument could be demonstrated in CHF patients. For comprehensive screening, both perspectives have to be included. First results indicate significant symptom burden, psychological distress and a high need for additional palliative care in CHF patients.

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“…Assessment, quality improvement, and timely referral can happen only through systematic monitoring using routine data collection, supplemented by specific audits that highlight unmet needs that can be addressed through timely involvement of palliative and hospice care. Glare et al 11 describe an approach to identify people with palliative care needs within oncology clinics by using referral criteria and systematic evaluation of clinic notes. The authors highlight that this process is resource intense, and that newer methods are needed.…”

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confidence: 99%