Palliative care screening tool: Does utilization promote early integration of palliative care for inpatient oncology patients?

Abstract

43 Background: Early integration of specialty Palliative Care (PC) in cancer patients improves quality of life and lowers medical costs. Engaging cancer patients early remains challenging. A checklist approach that evaluates type of malignancy, comorbidities, functional status, uncontrolled symptoms, readmission rates, and psychosocial/spiritual distress may prompt consultation to the PC team. We evaluated a palliative care screening tool’s (PCST) effect on promoting early PC consultation for oncology inpatients. Methods: A modified version of the Center to Advance Palliative Care screening tool was utilized by our hospital as part of the admission assessment. Registered nurses completed the PCST within 24 hours of admission for all adults. A PCST score of 3 or higher prompted staff to suggest a PC consult. A retrospective chart review of oncology patients who received a PC consult was performed to assess whether the screening tool score within 24 hours of admission impacted timing of a consult order. Effective tool utilization was considered to be a consult order within 36 hours of a high risk screen score. Results: From January through March 2014, 215 cancer patients screened with the PCST were found to have a score of 3 or higher. Seventy seven percent scored a 3 or higher, and PC consultation occurred in 16% of that patient cohort. Twenty three percent of PC consults occurred in patients scoring less than 3. The average number of days from admission to PC consult was 6 days. Conclusions: Using a PCST did not trigger PC consultation for inpatient cancer patients. Thirty four percent of the screened patients died during that admission, indicating a dramatic change in status from admission or ineffective prognostication, both barriers to early integration of PC. Our work suggests that a screening tool alone, even in a center with a well-embedded PC program, is not a sufficient means of effectively integrating PC into a patient’s hospital stay. Further work to identify patient characteristics that lead to consultation in both high and low risk patients is necessary.