Palliative care screening tools in the gynecologic oncology population: a narrative review

Abstract

Background and Objective: Patients with gynecologic malignancies experience high symptom burden associated with both their disease and sequelae of treatment, and are at risk for aggressive (and often futile) care at end-of-life. Early palliative care (PC) involvement is essential to improving quality of life in this population of patients through symptom management and advanced care planning discussions. The purpose of this review article is to discuss current PC screening tools used to trigger PC consultations for patients with gynecologic malignancies. PC screening tools are reviewed across both inpatient and outpatient clinical settings.Methods: A literature search was conducted utilizing PubMed ® and Excerpta Medica database (EMBASE ® ).Search terms included various combinations of palliative care, gynecologic oncology, gynecologic cancer, gynecologic malignancy, female genital tract cancer, trigger, consult, referral, and screen.

When insight yields inaction: the role of implementation science in improving palliative care integration

“…(1). Multiple evaluated prompts for referral yielded minimal to no change in palliative care referrals with up to 40% of patients eligible under stated criteria still not being referred to palliative care with limited understanding of persistent barriers and/ or missed opportunities (1). We propose that limited gains in palliative care utilization in the inpatient setting reflects the fact that at the time of inpatient admission, we have already missed the window for "timely" palliative care integration.…”

“…In general, inpatient palliative care referrals occurred when gynecologic cancer patients met a set of criteria (either a "yes" to the "surprise question", or a set of 2-4 clinical criteria such as late-stage disease, poorly controlled symptoms, etc.) (1). Multiple evaluated prompts for referral yielded minimal to no change in palliative care referrals with up to 40% of patients eligible under stated criteria still not being referred to palliative care with limited understanding of persistent barriers and/ or missed opportunities (1).…”

“…Vetter's review summarizes outcomes for six screening tools for palliative care referral among patients with gynecologic cancers (1). The development of multiple screening methods in both inpatient and outpatient settings shows interest in expanding use of palliative care services for eligible patients.…”

Perspectives on screening tools to identify palliative care needs in patients with advanced cancer

“…In a recent publication, Vetter presented a narrative review of palliative care screening tools in the gynecologic oncology population (6). As recommended in the ASCO guidelines (4), early palliative care can help to improve quality of life in patients with gynecologic cancer.…”