Palliative Care Screening: Appraisal of a Tool to Identify Patients’ Symptom Management and Advance Care Planning Needs

Flaherty, C Noelle; Fox, Kristin; McDonah, Donald; Murphy, Jennifer

doi:10.1188/18.cjon.e92-e96

Cited by 8 publications

(15 citation statements)

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“…The literature discussion about criteria to be used and the domains to be assessed, beyond the stage of the disease, already considered in all trials, includes symptoms, psychosocial distress, prognosis, trigger disease-related events and critical care planning issues 4 37–39. A number of PC need screening and assessment instruments have been developed and sometimes tested,39–50 but only a few of them were specifically designed to improve appropriate selection of cancer patients for referral to outpatient specialised PC 4 51. In the study by Paiva et al , the use of the PC referral tool would have increased referral rate by 3.2-fold 51.…”

Section: Discussionmentioning

confidence: 99%

Outpatient palliative care referral system (PCRS) for patients with advanced cancer: an impact evaluation protocol

et al. 2022

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IntroductionEarly palliative care (PC) in the clinical pathway of advanced cancer patients improves symptom control, quality of life and has a positive impact on overall quality of care. At present, standardised criteria for appropriate referral for early PC in oncology care are lacking. The aim of this project is to develop a set of standardised referral criteria and procedures to implement appropriate early PC for advanced cancer patients (the palliative care referral system, PCRS) and test its impact on user perception of quality of care received, on patient quality of life and on the use of healthcare resources.SettingSelected oncology clinics and PC outpatient clinic.Methods and analysisA scoping literature review and an expert consultation through a nominal group technique will be used to revise existing referral tools and to develop a new one, the PCRS. 25 patients will be enrolled in a pilot study to assess feasibility of the implementation of PCRS; 10 interviews with patients and healthcare professionals will be carried out to evaluate applicability.A pretest–post-test quasiexperimental study involving 150 patients before implementation of the PCRS and 150 patients after implementation will be carried out.Patient satisfaction with care received, quality of life and use of resources, and caregiver satisfaction with care will also be assessed to explore the impact of the intervention.Ethics and disseminationEthical approval for the study has been granted by the Institutional Review board of the Fondazione IRCCS Istituto Nazionale Tumori; approval reference INT201/19.Results will be disseminated through open access publications and through scientific communication presented at national and international conferences.Trial registration numberNCT04936568.

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Section: Discussionmentioning

confidence: 99%

Outpatient palliative care referral system (PCRS) for patients with advanced cancer: an impact evaluation protocol

et al. 2022

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“…A systematic symptom assessment and standardized care pathway need to be established and utilized in the oncology setting. Flaherty and colleagues (2018) developed a 10-question Palliative Assessment Screening Tool (PAST), which was used by staff nurses during the admission or transfer assessment of patients. The tool was purposely composed of a limited number of questions so that it would be fast and easy to complete.…”

Section: Discussionmentioning

confidence: 99%

Early Palliative Care for Oncology Patients: How APRNs Can Take the Lead

Mason

DeRubeis

Hesseltine

2021

JADPRO

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Background: Patients with cancer need expert and multidisciplinary care throughout the trajectory of their illness. Palliative care should be instituted early in the course of their disease. Early palliative care enables patients and their families to control physical, psychological, social, and spiritual symptoms of the disease. In our current health-care system, early palliative care is not being integrated due to a lack of education of providers and nurses, an infrastructure that does not support palliative medicine, and poor communication skills among practitioners. Methods and Results: The Palliative Care Quiz for Nursing (PCQN) completed by nurse practitioners at a large Midwest cancer center found that those nurse practitioners had a poor understanding of the basic precepts of palliative care. This is consistent with the current literature. Conclusion: Advanced practice nurses should be educated on the principles of palliative care, as they are perfectly situated to advance the integration of early palliative care in the oncology setting.

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“…As life expectancy and chronic disease continue to rise, palliative care has become a high priority for health care systems. Palliative care improves the quality of life, symptom burden, and patient satisfaction for patients with life-limiting and chronic illnesses while ensuring proper resource use and creating cost savings 1-3 . These benefits fulfill the Institute for Healthcare Improvement's Triple Aim of focusing on improving the patient experience of care and the health of populations while reducing health care costs 4 .…”

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confidence: 99%

“…Early palliative care for inpatient hospitalizations, regardless of patient acuity and level of care, is often defined as within 3 days of admission 6 . Research has demonstrated that timely identification of patients with a serious, life-limiting illness and referral within 3 days of a hospital admission improves patient-reported outcomes and is essential to providing early and effective palliative interventions 1,2,6,7 …”

mentioning

confidence: 99%

“…Previous studies reveal that clinicians are often inaccurate in determining prognosis, and as a result, palliative care is often implemented late 7,10,11 . Barriers to achieving early referrals include a lack of both education about palliative care benefits and processes to assist with identifying patients who may benefit from palliative care services 2 . To assist with barriers, it is recommended that palliative care be offered for all patients that have serious illnesses with an option to “opt-out” to make palliative care the default rather than a choice 12 …”

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confidence: 99%

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Development and Implementation of a Real-Time Inpatient Palliative Care Screening Process to Promote Earlier Palliative Care Referrals

Haranis

Lampkin

Roche-Green

et al. 2023

J Hosp Palliat Nurs

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Despite the previous development of criteria for palliative screening tools, there remains a lack of validated and practical screening processes for the general hospitalized patient population for everyday clinical use. This quality improvement project's aim was to implement a practical institution-based adult inpatient palliative care screening tool embedded into the electronic medical record with an automated alert process to assist in identifying patients earlier within hospital admission. The project used a preimplementation and postimplementation design and followed the Plan-Do-Study-Act process to measure the effectiveness of the tool and alert process in decreasing time from admission to palliative care referral and impact on referring patterns. During the project period, 1851 palliative care referrals were completed, and minimal difference (0.6%) was noted in the average time from admission to referral preimplementation and postimplementation (P = .939). There was a 3.7% increase in referrals postimplementation and a shift in referring service patterns (P = .321). Although the expected outcome of earlier palliative referrals during admissions was not met, the development and implementation of the tool and alert process is a step toward the creation of a standard practical tool for the general hospitalized patient population.

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Palliative Care Screening: Appraisal of a Tool to Identify Patients’ Symptom Management and Advance Care Planning Needs

Abstract: Using the PAST seems to improve the identification of patients with palliative needs, leading to better management of symptoms. The PAST is also likely useful in facilitating the completion of advance directives, but this requires further study.

Cited by 8 publications

References 8 publications

Outpatient palliative care referral system (PCRS) for patients with advanced cancer: an impact evaluation protocol

Outpatient palliative care referral system (PCRS) for patients with advanced cancer: an impact evaluation protocol

Early Palliative Care for Oncology Patients: How APRNs Can Take the Lead

Development and Implementation of a Real-Time Inpatient Palliative Care Screening Process to Promote Earlier Palliative Care Referrals

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