Responding to urgency of need: Initial qualitative stage in the development of a triage tool for use in palliative care services

Russell, Bethany; Sundararajan, Vijaya; Hennesy-Anderson, Nicole; Collins, Anna; Burchell, Jodie; Vogrin, Sara; Le, Brian; Brand, Caroline; Hudson, Peter; Philip, Jennifer

doi:10.1177/0269216318773221

Cited by 10 publications

(18 citation statements)

References 29 publications

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“…due to lack of experience, skills or time), patient needs may increase, leading to a referral to SPC services. 4,16 Cumulative needs, 4 which we show are common amongst people with a terminal illness, can be di cult to address within the short space of time available for a primary or secondary care consultation. Lack of con dence or experience in providing palliative care support, for instance prescribing or advance care planning, 27 may increase perceived complexity and referral for SPC.…”

Section: Discussionmentioning

confidence: 96%

“…16 Language and lack of clear terminology is also a barrier, for instance 'dying' can indicate a person recently diagnosed with a terminal illness, or someone approaching end of life. 16,17 Our study found that language was sometimes used selectively to make a case for referral, whereby the referrer chose words or documented symptoms to make a stronger case for referral, and omitted others as less in uential. Participants recognised the initial referral as only the start of a process, requiring further communication between the referrer and provider, culminating in the rst assessment.…”

Section: Discussionmentioning

confidence: 99%

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What Makes Palliative Care Needs “Complex”?: A Multisite Sequential Explanatory Mixed Methods Study of Patients Referred to Specialist Palliative Care

Finucane

Swenson

MacArtney

et al. 2020

Preprint

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Background: Specialist palliative care (SPC) providers tend to use the term ‘complex need’ to refer to the needs of patients who require SPC. However, little is known about “complex needs” on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on first referral to a hospice service. Methods: Multi-site sequential explanatory mixed method study consisting of a case-note review and focus groups with healthcare professionals in four UK hospices. Results: Documentation relating to 239 new patient referrals to hospice was reviewed; and focus groups involving 22 healthcare professionals conducted. Most patients had two or more needs documented on referral (96%); and needs were recorded across two or more domains for 62%. Physical needs were recorded for 91% of patients; psychological needs were recorded for 59%. Spiritual needs were rarely documented. Referral forms were considered limited for capturing complex needs. Referrals were perceived as influenced by the experience and confidence of the referrer and the local resource available to meet palliative care needs directly.Conclusions: Complexity was hard to detail or to objectively define on referral documentation alone. It appeared to be a term used to describe patients whom primary or secondary care providers felt needed specialist palliative care knowledge or support to meet their needs. Education and training in palliative care for primary care nurses and doctors and hospital clinicians could reduce the need for referral and help ensure that hospices are available to those most in need of specialist palliative care input.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

What Makes Palliative Care Needs “Complex”?: A Multisite Sequential Explanatory Mixed Methods Study of Patients Referred to Specialist Palliative Care

Finucane

Swenson

MacArtney

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…In this qualitative study, exploratory semi-structured interviews and focus groups were conducted with health-care professionals. The methodology, described in detail elsewhere, 6 entailed a stratified purposive sampling strategy to ensure participant representation of specialist palliative care providers across disciplines (primary, specialist; medicine, nursing, and allied health), service types (inpatient, hospital liaison, and community), and locations (metropolitan and rural) in Victoria, Australia. Specialist palliative care services in Australia are publicly funded, referral-based services available to patients who are based in acute hospitals, palliative care inpatient units, and in community care settings.…”

Section: Methodsmentioning

confidence: 99%

“…The primary analysis detailed the hierarchy of patient-level factors considered when assessing urgency of need, with a view to triage tool development. 6 In addition, the analysis revealed a series of themes relating to ethical concerns raised by participants in the context of decisions made affecting resource management at the end of life. These themes are the focus here.…”

Section: Methodsmentioning

confidence: 99%

“…We have sought, as part of a broader program of work, to develop a triage tool for palliative care services. As part of this triage tool development, we undertook a qualitative study to explore palliative care providers' practices toward triage 6 and their views of what should be included when assessing urgency in their patients' care. Through this qualitative exploratory work, a series of moral challenges were highlighted which throw focus upon the nature of ethical decision-making underpinning triage in palliative care.…”

Section: Introductionmentioning

confidence: 99%

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The Ethics of Prioritizing Access to Palliative Care: A Qualitative Study

Philip

Russell

Collins

et al. 2019

Am J Hosp Palliat Care

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Palliative care services are increasingly required to consider issues of resource, management as demand for services increases. The processes of triage have been developed in health care as a means of balancing need and resources in an equitable and reproducible way. Objective: This article sought to explore ethical issues associated with prioritization decisions in palliative care. Methods: As part of a broader series of studies of triage in palliative care, this qualitative substudy was conducted via semi-structured focus groups and individual interviews. Transcripts were subjected to thematic analysis. Setting/Participants: Twenty health professionals working across disciplines (primary, specialist; medicine, nursing, and allied health), service types (inpatient, hospital liaison, and community), and locations (metropolitan and rural) in Victoria, Australia. Results: Four themes emerged from the data: (1) Clinicians understood the tension between maintaining service quality with the delivery of a compromised service that sought to respond to demand. (2) They were aware of the influences of relationships and responsibilities upon patient waiting list prioritization, and (3) reported a hierarchy of suffering with certain types of clinical problems viewed as more urgent than others, for example, pain being more urgent than existential distress. (4) Clinicians noted a lack of transparency around waiting lists as they currently exist. Conclusions: This study revealed key ethical decision-making issues associated with prioritizing access to palliative care services. Making explicit the processes and influences upon decisionmaking provides greater transparency of health-care utilization at the end of life.

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Triaging the Terminally Ill—Development of the Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool

Russell

Vogrin

Philip

et al. 2020

Journal of Pain and Symptom Management

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Responding to urgency of need: Initial qualitative stage in the development of a triage tool for use in palliative care services

Cited by 10 publications

References 29 publications

What Makes Palliative Care Needs “Complex”?: A Multisite Sequential Explanatory Mixed Methods Study of Patients Referred to Specialist Palliative Care

What Makes Palliative Care Needs “Complex”?: A Multisite Sequential Explanatory Mixed Methods Study of Patients Referred to Specialist Palliative Care

The Ethics of Prioritizing Access to Palliative Care: A Qualitative Study

Triaging the Terminally Ill—Development of the Responding to Urgency of Need in Palliative Care (RUN-PC) Triage Tool

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