Demand for palliative care services in inpatient, community, outpatient and consultation services is increasing. In the context of finite resources, patients referred should undergo ‘triage’ – derived from the French term ‘trier’ meaning ‘to sort’ – the process of deciding which patients should be treated first based on how urgent their needs are.
A new study conducted in Victoria, Australia, explored palliative care providers’ practices and attitudes towards triaging palliative care needs and their views regarding the implementation of a standardised approach.
A method by which palliative care services can assess urgency is helpful to prioritise those patients and caregivers with the most pressing needs in the face of increasing demand for palliative services. Triage tools have been designed before, but have met with limited acceptability and acceptance.
A series of markers of urgency were identified in this qualitative study, including physical and psychological suffering, caregiver distress, discrepancy between care needs and care arrangements, mismatch between current site of care and desired site of death when in terminal phase and complex communication needs. Performance status and phase of disease were reported to be less informative when considered in isolation. The study did not include patients or carers.
This is the first time that complex communication needs have come up in a triage study.
Participants also articulated a concept not previously documented, which was the urgency of a discrepancy between the care needs of the patient and the capacity of their care arrangement. An example of this is a patient who with even a small deterioration in mobility may become unmanageable for their frail lay caregiver.
The list of triage factors generated in the study will be used to inform the development of a future triage tool with improved performance and clinical acceptability for use by palliative care services to prioritise their service provision and manage waiting lists.
Disclaimer : one of the Palliverse team was involved in this study but she was not involved in the writing of this article. I saw it on Twitter!