Responding to Urgency of Need in Palliative Care: Initial Stage of Development of a Decision Aid for Palliative Care Triage (S783)

Abstract

•Comprehend the factors that indicate urgency of palliative care needs.•Articulate the challenges and barriers associated with the triage process in palliative care. Demand for inpatient and community-based palliative care (PC) is growing. This trend is due to an aging population, earlier integration of PC in cancer care, increasing involvement of PC in non-malignant disease, and increasing community awareness of palliative care. Thus a diverse patient population referred from a variety of sources must be triaged for allocation of limited clinical resources. The aim of this study was to explore the experience of health professionals when triaging PC needs as an initial step in developing a decision aid that can facilitate the equitable, efficient and transparent allocation of PC services by urgency of need. Twenty purposive-sampled general and specialist PC health professionals (medical n=9, nursing n=9, allied health n=2) from metropolitan and regional locations across Victoria, Australia participated in focus groups or individual interviews. A semi-structured interview guide sought to explore perspectives on indicators of urgency and facilitators and barriers to implementation. Transcripts were subjected to deductive thematic analysis by two researchers. Health professionals shared commonality in the factors they found useful to determine urgency, such as current or impending mismatch between care needs and care environment. Performance status was reported to be less important when considered in isolation. Interpersonal and ethical challenges associated with the triage process and systemic barriers for implementing a decision aid were highlighted. Indicators of urgent PC needs are complex, dynamic and often inter-related, but are useful for PC health professionals undertaking the difficult task of triage. The results of this study will form the basis of a future discrete choice experiment to determine the relative importance of each triage factor.