Referral Criteria for Outpatient Palliative Cancer Care: A Systematic Review

Hui, David; Meng, Yee Choon; Bruera, Sebastian; Geng, Yimin; Hutchins, Ron; Mori, Masanori; Strasser, Florian; Bruera, Éduardo

doi:10.1634/theoncologist.2016-0006

Cited by 139 publications

(115 citation statements)

References 44 publications

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“…14e17 More research is needed to understand the barriers to earlier referral to palliative care for such patients. 18,19 The data also suggest that patients with low or no insurance had a higher number of palliative care visits, which is consistent with the findings of higher physical and psychosocial distress and higher risk of aberrant opioid use. At the same time, it is reassuring to find that insurance status was not a barrier to continued provision of palliative care services once access was established.…”

Section: Discussionsupporting

confidence: 82%

Timing of Referral and Characteristics of Uninsured, Medicaid, and Insured Patients Referred to the Outpatient Supportive Care Center at a Comprehensive Cancer Center

Azhar

Yennurajalingam

Ramu

et al. 2018

Journal of Pain and Symptom Management

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Section: Discussionsupporting

confidence: 82%

Timing of Referral and Characteristics of Uninsured, Medicaid, and Insured Patients Referred to the Outpatient Supportive Care Center at a Comprehensive Cancer Center

Azhar

Yennurajalingam

Ramu

et al. 2018

Journal of Pain and Symptom Management

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“…Lack of both standardised clinical pathways and systems for informationsharing have impeded the establishment of stable and integrated EOL care across relevant agencies [60]. Efforts to develop web-based system to monitor and refer patients have encountered multiple difficulties because of concerns about data security [61] and heterogeneity in illness trajectories [62,63].…”

Section: Discussionmentioning

confidence: 99%

End-of-life care in rural general practice: how best to support commitment and meet challenges?

et al. 2019

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Background: Few studies have specifically assessed the scope, nature and challenges of palliative and end-of-life care in rural general practice. These knowledge gaps limit the development of evidence-based policies and services for patients in the last months of life. This study aimed to explore the perspectives of general practitioners (GPs) and other stakeholders on rural GPs' involvement and challenges in providing palliative and end-of-life care in regional Australia. Methods: A qualitative study involving five focus groups with 26 GPs based in rural/regional Western Australia together with 15 individual telephone interviews with four GPs and 11 other stakeholders involved in end-of-life care across Australia. Results: The rural GPs' central role in end-of-life care was recognized by the majority of participants but multiple challenges were also identified. Some challenges were comparable to those found in urban settings but others were more pronounced, including resource limitations and lack of training. Inappropriate payment models discouraged GPs' involvement in some aspects of end-of-life care, such as case conferences and home visits. Compared to GPs in urban settings, those in rural/regional communities often reported closer doctor-patient relationships and better care integration and collaboration. These positive aspects of care could be further developed to enhance service provision. Our study highlighted the importance of regular interactions with other professionals and patients in providing end-of-life care, but many GPs and other stakeholders found such interactions more challenging than the more "technical" aspects of care. Conclusions: Rural/regional GPs appear to be disproportionately affected by inappropriate payment models and limited resources, but may benefit from closer doctor-patient relationships and better care integration and collaboration relative to urban GPs. Systematic collection of empirical data on GP management at end-of-life is required to build on these strengths and address the challenges.

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“…(119) In a systematic review of the literature to characterize referral criteria to outpatient palliative care for patients with cancer, 13 of 21 included studies specified symptom distress as a reason for referral. (120) Among these studies, ESAS was the most commonly used symptom assessment scale, with 7 of the 9 studies that reported the use of a validated scale employing ESAS. (121–127) However, only one study stated a symptom intensity cutoff of ≥6/10 was needed to trigger a referral.…”

Section: Future Developmentsmentioning

confidence: 99%

The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments

Hui

Bruera

2017

Journal of Pain and Symptom Management

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534

428

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Context Routine symptom assessment represents the cornerstone of symptom management. ESAS is one of the first quantitative symptom assessment batteries that allows for simple and rapid documentation of multiple patient-reported symptoms at the same time. Objective To discuss the historical development of ESAS, its current uses in different settings, and future developments. Methods Narrative review Results Since its development in 1991, ESAS has been psychometrically validated and translated into over 20 languages. We will discuss the variations, advantages and limitations with ESAS. From the clinical perspective, ESAS is now commonly used for symptom screening and longitudinal monitoring in patients seen by palliative care, oncology, nephrology, and other disciplines in both inpatient and outpatient settings. From the research perspective, ESAS has offered important insights into the nature of symptom trajectory, symptom clusters and symptom modulators. Furthermore, multiple clinical studies have incorporated ESAS as a study outcome and documented the impact of various interventions on symptom burden. On the horizon, multiple groups are actively investigating further refinements to ESAS, such as incorporating it in electronic health records, employing ESAS as a trigger for palliative care referral, and coupling ESAS with personalized symptom goals to optimize symptom response assessment. Conclusion ESAS has evolved over the past 25 years to become an important symptom assessment instrument in both clinical practice and research. Future efforts are needed to standardize this tool and explore its full potential to support symptom management.

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Referral Criteria for Outpatient Palliative Cancer Care: A Systematic Review

Cited by 139 publications

References 44 publications

Timing of Referral and Characteristics of Uninsured, Medicaid, and Insured Patients Referred to the Outpatient Supportive Care Center at a Comprehensive Cancer Center

Timing of Referral and Characteristics of Uninsured, Medicaid, and Insured Patients Referred to the Outpatient Supportive Care Center at a Comprehensive Cancer Center

End-of-life care in rural general practice: how best to support commitment and meet challenges?

The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments

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