Vol 12, No 2 (2018)
Research paper
Published online: 2018-06-06
Palliative Care Referral Form: An urgent indications triage tool for palliative and hospice care — prospective observational study
Palliat Med Pract 2018;12(2):67-75.
Abstract
Qualification to palliative care is more demanding when the number of referred patients exceeds the admission capabilities of an institution. In such cases the selection of urgent admission needs (when management aside from hospice care is problematic) may be essential. For this purpose the palliative care referral form (PCRF) containing additional information on disease stage, patient’s performance, symptoms of suffering, previously applied therapies and social concerns was developed and prospectively analyzed.
The aim of the study was to assess the qualification to palliative care accuracy in a group of 41 patients based on the PCRF. At first the qualification was based solely on the PCRF data, then (on the second day after admission) a structured interview with an attending physician was conducted. Pairs of these data were compared and analyzed.
All palliative referrals were legitimized on admission. Among 26 patients triaged as “urgent”, 19 were such on admission, within 15 staged as “stable” 13 were confirmed later. Also, the disease stage and patients’ performance were usually confirmed on admission. The high PCRF ability to predict the need of urgent implementation of palliative care was observed. (positive predictive value of 73,1%, sensitivity 90,5%)
The PCFR which is legitimate, provides the essential information for preliminary qualification to palliative care and accurate assessment of its urgent indications. It may simplify and accelerate the process thus lowering costs. Wider practical application of the PCRF in the hospice care is proposed.
Keywords: referralpalliative carehospice care
References
- Rozporządzenie Ministra Zdrowia z 29 października 2013 r. (Dz.U. 13.1347) w sprawie świadczeń gwarantowanych z zakresu opieki paliatywnej i hospicyjnej.
- Ciałkowska–Rysz A, Dzierżanowski T. Stan opieki paliatywnej w Polsce w 2014 roku. Med Paliat. 2016; 8: 120–127.
- Grądalski T, Sojka J, Straszak K. Koszty opieki nad chorymi z nowotworem złośliwym u kresu życia na oddziale wewnętrznym szpitala i w hospicjum stacjonarnym. Med Paliat. 2017; 9: 89–97.
- Rozporządzenie Ministra Zdrowia z dnia 26 września 2005 r. w sprawie kryteriów medycznych, jakimi powinni kierować się świadczeniodawcy, umieszczając świadczeniobiorców na listach oczekujących na udzielenie świadczenia opieki zdrowotnej. Dz.U. 2005 nr 200 poz. 1661.
- § 9 ust. 2 Rozporządzenia Ministra Zdrowia z dnia 9 listopada 2015 r. w sprawie rodzajów, zakresu i wzorów dokumentacji medycznej oraz sposobu jej przetwarzania (Dz. U. z dnia 8 grudnia 2015 r. Poz. 2069).
- Radziwiłł K. Kodeks Etyki Lekarskiej. Odcinek 43: Wydawanie zaświadczeń lekarskich. Med Prakt. 2017; 6: 119–120.
- Ciałkowska–Rysz A, Dzierżanowski T, Łuczak J, et al. Podsumowanie pracy Zespołu do spraw opieki paliatywnej i hospicyjnej (sierpień 2011 r. – czerwiec 2012 r.). Med Paliat. 2014; 6: 177–189.
- http://www.goldstandardsframework.org.uk/ (02. 03. 2018 r.).
- https://www.icgp.ie/go/in_the_practice/information_technology/national_referral_form (02.03.2018 r.).
- Philip JAM, Le BH, Whittall D, et al. The development and evaluation of an inpatient palliative care admission triage tool. J Palliat Med. 2010; 13(8): 965–972.
- Tracey G, Cunningham J, Adams K. ‘Pending Triage’ Review of the Accuracy of Triage of Referrals to an Urban Community Palliative Care Team. 15th World Congress of the EAPC, 18–20 May 2017. Eur J Palliat Care. 2017: 800.
- Kavanagh M. Triage Nurse Specialist in Palliative Care. Eur J Palliat Care. 2015; 22: 78–79.
- Russel B, Hennesy–Anderson N, Collins S, et al. Responding to Urgency of Need In Palliative Care: Initial Stages in the Development of a Decision Aid for Palliative Care Triage. Palliat Med. 2016; 30(NP42).
- Bennett M, Adam J, Alison D, et al. Leeds eligibility criteria for specialist palliative care services. Palliat Med. 2000; 14(2): 157–158.
- Van Mechelen W, Aertgeerts B, De Ceulaer K, et al. Defining the palliative care patient: a systematic review. Palliat Med. 2013; 27(3): 197–208.
- Gradalski T, Wesolek E, Kleja J. Terminal cancer patients' informed consent for palliative care admission and their quality of life. J Palliat Med. 2012; 15(8): 847.
- Grądalski T, Kochan K, Wesołek E, et al. Zgoda chorego na leczenie u kresu życia. Med Paliat Prakt. 2010; 4: 119–124.
- Temel J, Greer J, Muzikansky A, et al. Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer. N Engl J Med. 2010; 363(8): 733–742.
- Vanbutsele G, Pardon K, Van Belle S, et al. Effect of early and systematic integration of palliative care in patients with advanced cancer: a randomised controlled trial. Lancet Oncol. 2018; 19(3): 394–404.
- Holmenlund K, Sjøgren P, Nordly M. Specialized palliative care in advanced cancer: What is the efficacy? A systematic review. Palliat Suppor Care. 2017; 15(06): 724–740.
- Brant JM. Palliative care for adults across the cancer trajectory: from diagnosis to end of life. Semin Oncol Nurs. 2010; 26(4): 222–230.
- Brereton L, Clark J, Ingleton C, et al. What do we know about different models of providing palliative care? Findings from a systematic review of reviews. Palliat Med. 2017; 31(9): 781–797.
- Hui D, Bruera E, Hui D, et al. Models of integration of oncology and palliative care. Ann Palliat Med. 2015; 4(3): 89–98.
- Masso M, Allingham SF, Banfield M, et al. Palliative Care Phase: inter-rater reliability and acceptability in a national study. Palliat Med. 2015; 29(1): 22–30.
- Mather H, Guo P, Firth A, et al. Phase of Illness in palliative care: Cross-sectional analysis of clinical data from community, hospital and hospice patients. Palliat Med. 2018; 32(2): 404–412.
- Simmons CPL, McMillan DC, McWilliams K, et al. Prognostic Tools in Patients With Advanced Cancer: A Systematic Review. J Pain Symptom Manage. 2017; 53(5): 962–970.e10.
- Hui D, Meng YC, Bruera S, et al. Referral Criteria for Outpatient Palliative Cancer Care: A Systematic Review. Oncologist. 2016; 21(7): 895–901.
- Addington-Hall J, Fakhoury W, McCarthy M. Specialist palliative care in nonmalignant disease. Palliat Med. 1998; 12(6): 417–427.
- Dorman–Okońska P. Jak określić wskazania nagłe do objęcia opieką paliatywną – analiza stanu prawnego. Med Paliat. 2012; 4: 41–46.
- Bętkowska IA, Żylicz Z. Stany naglące w opiece paliatywnej Praktyka kliniczna poparta faktami. Med Paliat Prakt. 2017; 11: 153–165.
- Quill TE, Abernethy AP. Generalist plus specialist palliative care--creating a more sustainable model. N Engl J Med. 2013; 368(13): 1173–1175.
- Smoleń A. Biostatystyka w badaniach medycznych i praktyce klinicznej. Pol Arch Med Wewn. 2016; 126(Special Issue 1): 1–24.
