Integrating Palliative Care Screening into Primary Care

Abstract

Problem Statement: As patients with chronic, life-limiting conditions live longer, it is important to continuously evaluate quality-of-life. The lack of initiation of a palliative care consult at the time of diagnosis with a chronic, life-limiting condition results in an increase in disease burden and functional decline. Purpose: The purpose of this project was to determine if the implementation of a palliative screening and referral process in the primary care setting as compared with usual care (subjective physician referrals without standard screening tool) would help to increase the number of palliative care referrals and patient access to palliative care service. Methods: A multi-step exploratory project design was used with convenience sampling. This project encompassed: 1.) collection of aggregate data; 2.) development of a palliative care staff educational program; 3.) implementation of a palliative screening tool; 4.) development of a process for referring patients to palliative care; and 5.) provision of improved access to palliative care services for eligible patients. Results: Descriptive and inferential statistics explored overall provider compliance with use of the palliative care screening tool and comparisons of the number of patients who met criteria for palliative care referrals to the number of actual referrals. A total of 410 patients were seen, which included 448 visit encounters. The majority were female (61%, n=252) and Caucasian/White (81%, n=331). Age ranged from 18 to 99 years. Screening compliance was 33% (goal of 100%). Twenty patients met criteria for a palliative care referral. However, only 9 referrals were actually made. Due to low yield of referrals, correlations between palliative care referrals and demographic variables such as: age, gender, insurance, and diagnosis were not possible. Significance: The increased integration of palliative care knowledge into the primary care setting helped to facilitate palliative care referrals. Based on the literature reviewed and data collected from this DNP project, the recommendation remains for more studies to be conducted on the use of palliative care screening tools in the primary care setting.