Standardized Palliative Care Screening Can Increase Much-Needed Referrals

When clinicians had a standard tool to refer patients to palliative care, quality of care and patient referrals were both improved, according to a recent study.

Cancer providers often feel that their patients could benefit from receiving palliative care sooner, but may lack the tools to properly refer them. A small study at the Huntsman Cancer Institute of the University of Utah analyzed the effectiveness of a standardized assessment and referral tool for palliative care.

Study author Amanda Dailey-Hansen, ACNP-DNP, BSN, RN, OCN, presented her team’s findings at the 46th Annual ONS Congress.

“In general, many of us in oncology may know that palliative care is poorly utilized, even in our area,” Dailey-Hansen said. “This is due to a lot of different barriers that patients report, as well as providers. Patients largely report access barriers and providers report referral barriers or hesitancy.”

Dailey-Hansen noted that health care providers may feel that patients have a negative view on palliative care or may feel that they are being given up on.

“But research actually shows otherwise. In 2014, the Institute of Medicine published a report that talked about the importance of integrating palliative care with primary oncology care… A lot of research also shows that patients with advanced illness can gain a lot of benefit from adjunctive palliative care in addition to their primary oncologic care, especially and even when this is initiated by nurses through standard protocol.”

To decrease the barriers to palliative care referral, the team went through tools that were already available in their electronic health record. They then took that and created a standardized assessment and referral tool, which was trialed for 60 days on 11 patients. The tool would help clinicians determine if a patient was eligible for palliative services.

The research team also screened providers – including physicians, nurse practitioners, physician assistants, and registered nurses – on their common beliefs about palliative care before and after the implementation of the tool.

“All in all, the developed tool was deemed an asset to nurses on the trial unit. It supported them in the ways that they would have wanted it to,” Dailey-Hansen said. “Quality of care and assessment and referral to palliative care teams was improved during the study timeframe, which really was the goal of the project.”

Providers’ perception on the new tool was not yet determined due to the short trial period, so Dailey-Hansen said that longer follow-up – as well as trying it in a larger patient population – could be beneficial.

“The goal was to improve provider practice value overall,” Dailey-Hansen said. “And this tool was determined to do that, which was a great finding.”