Quality improvement initiative: increasing specialty palliative care referral rates for patients living with advanced cancer in an adult outpatient oncology clinic

Abstract

Background: Advanced cancer, which includes distant metastasis, and its treatment can negatively impact quality of life. Specialty palliative care utilization is associated with significant improvements in quality of life, symptom burden, emotional wellbeing, and end of life planning for patients living with advanced cancer. Local problem: Pre-implementation data from an outpatient oncology clinic demonstrated a lack of standardized screening processes for palliative care needs and low specialty palliative care utilization for adult patients living with advanced cancer. Methods: This quality improvement project aimed to implement a systematic screening process for palliative care needs among patients living with advanced cancer. Goals of the project were to (1) screen at least 90% of patients living with advanced cancer for palliative care needs; and (2) increase post-implementation specialty palliative care referral numbers. Intervention: The intervention involved screening all advanced cancer patients for palliative care needs using standardized screening criteria and the Edmonton Symptom Assessment System Revised for Cancer (ESAS-r). The intervention also included development of a standardized specialty palliative referral process. Results: Post implementation data revealed palliative needs screening rates ranging from 33% to 91%, and an increase in specialty palliative care referrals numbers from zero to 20. Conclusions: This project demonstrated that a standardized palliative needs screening process and referral pathway for patients living with advanced cancer can increase specialty palliative care utilization, thereby increasing the opportunity for patients living with advanced cancer to realize its benefits.