Annual Meeting Proceedings Part 1 - American Society of Clinical ...

590s Patient and Survivor Care
9094 General Poster Session (Board #44H), Sat, 8:00 AM-12:00 PM
Feasibility of screening hospitalized cancer patients for palliative care.
Presenting Author: Paul A. Glare, Memorial Sloan-Kettering Cancer Center,
New York, NY
Background: The National Comprehensive Cancer Network Palliative Care
(PC) Guideline recommends screening all oncology patients for PC needs,
and to call a PC consult when referral criteria are met. There are no data on
the feasibility or impact of this approach. The aim of this pilot study was to
assess the feasibility of PC screening in patients admitted to a comprehensive
cancer center (CCC). Methods: Design: Observational study. From
11/1/10 to 1/31/11, floor nurses screened all patients the day after
admission under the two teams (“Team A” and “Team B”) of the
Gastrointestinal Oncology Service at Memorial Sloan-Kettering Cancer
Center. Team A patients were also evaluated by the referral criteria.
Endpoints: Patients screened ‘positive’ if they had advanced disease and
any of the clinical situations nominated in the Guideline. The referral
criteria triggered PC consults in Team A patients; clinical judgment
triggered Team B consults. Outcomes: Screening rates, nursing satisfaction
survey, clinical and operational metrics. Results: Ninety percent (229
of 254) of admissions were screened. Both Teams’ patients were seriously
ill (see Table), and it was no surprise that 63% (145 of 229) screened
positive. Survey respondents (response rate 50%) rated screening as
simple, quick and helpful, although nurses scored the extent of disease
wrong in 16%. Sixty eight percent (55 of 780) of Team A patients who
screened positive met the referral criteria. This generated more consults on
Team A, but the effect on key outcomes was not significant (n.s.).
Conclusions: Screening for PC was feasible in this setting, but is a
challenging concept in terms of reliability, validity and timing. The value to
a CCC of increasing PC access via referral criteria needs evaluation in
well-designed trials.
Screened patients Team A (n�113) Team B (n�116) p value
Status on admission
Time since diagnosis (months) 13 15 n.s.
Advanced disease 92% 97% n.s.
Best supportive care 36% 39% n.s.
Died within next 3 months 33% 45% n.s.
Pain score > 7/10 33% 34% n.s.
Screen positive 71% 56% 0.028
Outcomes
Consults 42% 15% �0.0001
Pain score > 7/10, day 4* 13% 38% n.s
Median length of stay (days) 4 4 n.s.
Died in hospital 4% 7% n.s.
Hospice referral 19% 21% n.s.