Screening for palliative care needs in primary care

Abstract

Statement of the problem. Palliative care is a fast growing, yet underutilized specialty that focuses on patient-perceived needs and goals of care. As the US population becomes older and sicker, the need for palliative care services will only grow. There are a variety of known benefits to early palliative care intervention. Unfortunately, barriers to palliative care referral widely described in the literature are reflected at the local organization. Methods. This project took place at a healthcare organization in Montana. Two primary care teams incorporated a palliative care screening tool into daily huddles for all adult patients with elevated risk scores, according to an internal risk-stratification tool. Using a data collection tool, the care teams recorded screening data including the patient's age, risk score, payer, screening result, whether the patient was referred to palliative care, and the credentials of the screener. A post-intervention verbal debriefing was used to understand the perspectives of the participating care team members and the impact of the screening process at the conclusion of the project. Results. During the six-week data collection period there were 188 high-risk patient encounters. Screening was completed on high-risk patients 43% (n=21) of the time in the first data collection cycle, 63.5% (n=47) of the time in the second data collection cycle, and 82% (n=38) of the time in the final data collection cycle. There were 22 patients with positive screening results, indicating unmet palliative care need. Ultimately, 9 patients were referred to palliative care. Discussion. Though the pilot implementation of the palliative care screening tool did not meet the pre-determined goals, several valuable insights were gained from the project. Barriers to incorporating the screening process included integrating a paper-based process into a primarily digital practice, staffing and other impacts of COVID-19, changes to established workflows and unforeseen procedural issues. The screening tool was found to be acceptable by the project development team and screening for palliative care need was deemed valuable by the care teams. Adjustments for future iterations of this screening protocol were recommended.