Palliative care screenings identified more patients for referral

Issue: April 10, 2012

Screening identified more patients for referral to a hospital’s palliative care team than normal evaluation, according to findings of a single-center study.

The involvement of the palliative care team also led to more discussions about hospice, but it did not prolong patients’ average length of stay.

Paul A. Glare, MD, chief of the pain and palliative care service at Memorial Sloan-Kettering Cancer Center, and colleagues evaluated the implementation and effect of the National Comprehensive Cancer Network (NCCN) palliative care guideline. The guideline recommends screening patients for palliative care needs and calling a consult when referral criteria are met.

The study took place in the gastrointestinal oncology service at Memorial Sloan-Kettering Cancer Center from Nov. 1, 2010, to Jan. 28, 2011.

The admitting nurse screened all patients hospitalized as part of two teams.

A total of 229 patients were screened, 113 from Team A and 116 from Team B. When patients on Team A met the guideline’s referral criteria, palliative care consults were triggered.

The referral criteria triggered palliative care consults in 72 (64%) patients from Team A. Less than 10% of patients typically are referred after standard evaluation, according to background information in the study.

The Team A patients referred to the palliative care team were significantly more likely to die within 6 months (63% vs. 39%, P<.02), the results showed. The patients referred for consultations had the same length of stay (median 4 days). They also participated in significantly more hospice discussions (35% vs. 14%, P<.05) and reported slightly better pain relief.

The nurses reported that screenings took less than 5 minutes per patient, and that the process was simple and helpful.

“It is feasible to screen hospitalized patients for palliative care needs, and the prevalence of needs is very high,” the researchers wrote.

However, more data are necessary to support widespread implementation of the NCCN guideline and the delegation of additional resources necessary to handle the increased workload, they said.

For more information:

Glare P. Abstract #418-A. Presented at: The Annual Assembly of the American Academy of Hospice and Palliative Medicine & Hospice and Palliative Nurses Association; March 7-10, 2012; Denver.