Palliative Care Referrals in the Oncology Population

Abstract

Purpose: Palliative care (PC) focuses on relief of suffering and improving quality of life for patients and families facing life-limiting illness. When a patient is told their life may be cut short, it is important to help them define their own focal points. Using PC in oncology care can help address goals, and make them obtainable by decreasing symptom burden, completing advanced care planning, and assisting to increase quality and quantity of life. Unfortunately, PC is highly underused within the inpatient oncology population. It is frequently introduced too late in the patient’s plan of care leading to distress. In line with the evidence around the need for increased PC services, the purpose of this quality improvement project is to assess if using a validated screening tool would increase the potential PC referrals by 10% over a two-month period. Rationale: Using PC in standardized oncology care can help patients and families not only identify goals, but also make them obtainable by decreasing symptom burden, completing advanced care planning, and assisting to increase their quality and quantity of life. Barriers to implementation exist that include lack of knowledge on when to implement PC services, what diagnosis would qualify, and that PC is only associated with end of life. Research has shown that early implementation of PC has positive patient outcomes compared to late implementation in the oncology population. Using a validated screening tool would allow oncology providers and nurses to understand and help identify when an oncology patient would benefit from a PC referral in the inpatient setting. Approach Methods: The project aims to assess if the implementation of a screening tool will adequately increase the number of potential PC referrals in our organization over a two-month period. The evidence-based screening tool chosen for this project was the Palliative Care Screening Tool adapted from the National Comprehensive Cancer Network guidelines. Oncology nurses within the organization were educated on tool use through a Prezi Presentation prior to implementation and again half way through the project. Implementation consisted of a hard copy of the PC screening tool administered by the nurse on every oncology admission and again on day seven of hospitalization. When a patient scored five or higher, they were identified as someone who would benefit from a PC referral. Numbers of potential referrals, as well as how nurses perceived using the PC screening tool including identification of barriers were assessed with the System Usability Scale. Results/Conclusion: Results indicated 132% of potential PC referrals over the two-month period. Results also indicate that a majority of the participants agreed that the PC screening tool was an easy tool to use. This quality improvement project used a quantitative descriptive method that resulted promising findings, hopefully, to implement the oncology PC referral screening tool hospital wide. The findings indicate that the PC screening tool was usable by participants and that using a PC screening tool can increase PC referrals. Despite the limitations discussed, this project demonstrates positive results and can guide future projects of this type.