Feasibility of screening hospitalized patients for palliative care.

Abstract

176 Background: The National Comprehensive Cancer Network (NCCN) Palliative Care (PC) Guideline recommends screening all oncology patients for PC, and to call a consult when the referral criteria are met. There are no data on the feasibility or impact of following this recommendation. Methods: Design: Prospective observational study. From 11/1/10 to 1/31/11, floor nurses screened all admissions under the two teams (“Team A” and “Team B”) of the Gastrointestinal Oncology (GIO) service at Memorial Sloan-Kettering Cancer Center. Team A patients were also evaluated by the referral criteria. Endpoints: Patients screened ‘positive’ if they had any of the clinical situations nominated in the Guideline. A PC consult was triggered on Team A patients who met the referral criteria. Team B patients got PC consults based on clinical judgment. Outcomes: screening rates, nursing satisfaction survey, clinical and operational metrics. Results: 90% (228 of 254) admissions were screened, typically taking < 5 minutes. Both teams’ patients were seriously ill (Table 1a), and it is no surprise 75% (170 of 228) screened positive and that 68% (60 of 87) of screen-positive Team A patients met the referral criteria. Screening generated more consults on Team A than Team B (47 vs. 15 p<0.0001), and they were referred earlier (Table 1b). Nurses (response rate 50%) rated screening as quick and simple but not very helpful. Conclusions: Screening for PC was feasible and sustainable, increasing access to specialist services. The value to a comprehensive cancer center of markedly increasing PC consults through implementation of guidelines needs to be evaluated in well-designed trials. [Table: see text]