The use of a screening tool at hospital admission has helped oncology nurses connect patients with palliative care clinicians earlier in their disease trajectory.
Researchers from Johns Hopkins University and Maryland University studied the use of an 11-item questionnaire adapted from the National Comprehensive Cancer Network’s Palliative Care Clinical Practice Guidelines in Oncology. Using this tool, they gathered information about patients’ potential palliative care needs, including performance status, extent of disease, comorbidities, prognosis and palliative care-specific problems.
The study defined “palliative care-specific problems” to include things like medical decision making, moderate to severe distress, uncontrolled symptoms, prolonged length of stay and patient or family requests for a palliative care (PC) consultation.
“Patients who receive late referrals to PC cannot benefit from the full range of palliative services and are more likely to die in the hospital,” the authors wrote. “When nurses appropriately identify and convey PC needs, patients are more likely to be discharged to home with home care service before death, which decreases the rate of readmissions and the use of acute care services such as the intensive care unit or emergency department.”
Patients with scores of five or more on the questionnaire indicated a need for a conversation about palliative care, according to the study.
The tool identified palliative care needs in about 76% of 134 patients included in the research. Prior to implementing the tool, about 23% of similar patients received palliative consults. Post-intervention, this number rose to 59%. Evidence also showed that readmission rates or length of stay declined, the study found.
“Using a validated PC screening tool to screen adult patients with solid tumor malignancies on admission produced clinically and statistically meaningful results,” the authors wrote. “It yielded a statistically significant increase in PC consultation rates and clinically significant decreases in the average patient [length-of-stay] and readmission rates. This project’s findings align with and strengthen the body of evidence that using validated PC screening tools can help increase the use of PC services.”
