Adherence to Measuring What Matters: Description of an Inpatient Palliative Care Service of an Urban Teaching Hospital

Effect of a Palliative Care Screening Tool for Oncology Patients

This pilot quality improvement project implemented an adapted screening tool within an outpatient oncology center for patients with advanced cancer to identify unmet patient needs, aid decision making, and increase the number of patients referred to palliative care. Baseline data were collected via retrospective convenience sampling to track the number of palliative care referrals generated from the oncology center. Over a 6-week period, screening was implemented during patient evaluations with their oncologist to identify needs for palliative care intervention and as a decision aid to support referring patients to a specialized palliative care service. During the pilot, key nursing staff were affected by COVID-19, and the ideal sample size was not met. Despite a small sample size, the number of palliative care referrals increased. The increased number of referrals affirms the use of a screening tool to identify palliative care needs and as a formal decision-making process to improve patient access to palliative care.

Evaluation of a Quality Improvement Intervention to Improve Pediatric Palliative Care Consultation Processes

BACKGROUND

A critical aspect of pediatric palliative care consultations is the assessment and documentation of patient and family needs. While these assessments usually include a focus on physical pain, there is less standardization of assessments of other physical symptoms and psychosocial, emotional, or spiritual needs.

AIMS

To improve the breadth of assessment of psychosocial and emotional needs, screen for symptoms other than pain among pediatric patients utilizing palliative care services, and to increase documentation of assessment data from 30%-40% to 80% through practice changes implemented in 2 Plan-Do-Study-Act (PDSA) cycles.

METHODS

This quality improvement project involved implementing provider education and adapting the palliative care consultation template in the electronic health record to improve breadth and consistency of assessment and documentation during consultations by the interdisciplinary pediatric palliative care team. Two PDSA cycles were performed. Chi squared tests and statistical control charts were used for data analysis.

RESULTS

There was statistically significant improvement in the inclusion of documentation of a pediatric palliative care social work note from baseline (32%) to Cycle 2 (57%). Physical symptom screening declined slightly, but not significantly (p = .32) and socio-emotional discussions also declined but not significantly (p = .05).

CONCLUSIONS

Screening for physical symptoms and discussions with patients and families about psychosocial/emotional needs during the initial palliative care consultations are extremely important in providing effective, holistic, patient-centered care. There is a need for development of pediatric-centric guidelines and quality measures to evaluate pediatric palliative care programs; further research is indicated to determine methods for evaluating compliance with these guidelines.