ESMO 2017: 'Triggers': A New Tool to Assess Patients’ Palliative Needs

Key Points

  • The Triggers tool allows oncologists to assess their patients’ needs for palliative care at an earlier stage.
  • Of the patients reviewed 75% triggered positive on one or more of the tool items.
  • Among the ‘Trigger positive’ cohort, 97% were identified as having at least a moderate need for specialist palliative care—even though 81% of them were functioning well.

A new tool to identify patients who would benefit from early palliative care was presented at the European Society for Medical Oncology (ESMO) 2017 Congress in Madrid (Abstract LBA54_PR).

The so-called “Triggers” tool, developed by the London Cancer Alliance to help clinicians in the UK recognize patients who need an early referral to specialist palliative care, has been successfully piloted at The Royal Marsden NHS Foundation this year. The preliminary results of the service evaluation presented at ESMO 2017 prove the usability of this tool by primary care teams, and point to the feasibility of establishing the integrated service between oncology and palliative care teams on a wider scale. 

Palliative care has traditionally been associated with optimizing the quality of life (QoL) at the end of life. However, research has shown that giving patients early access to specialist palliative care can have many benefits, including improving their prognosis.

The Triggers tool allows oncologists to assess their patients’ needs in this respect at a much earlier stage and to potentially refer them to specialist palliative care alongside active treatment.

Service Evaluation Results

In its pilot phase, the tool was introduced for new patients at The Royal Marsden’s lung oncology outpatient clinic: in the first 4 months of the service, 84% of eligible patients were reviewed within 2 months of their first clinic attendance.

“We found that 75% of the patients reviewed triggered positive on one or more of the tool items. Of the ‘Trigger positive’ cohort, whose needs were then assessed by a palliative care team, 97% were identified as having at least a moderate need for specialist palliative care—even though 81% of them were still functioning well, ranking in the top two scores on the scale used to assess how a disease affects a patient’s daily living abilities,” said Jayne Wood, MBBS, FRCP, who led the evaluation.

“This tells us that we are addressing a real need, and that the tool is picking up a group of patients who have a real potential to benefit from referral to specialist palliative care. The goal is for the tool to become standard and easy for anyone on a patient’s primary care team to use—for us, the next step will be to expand into other tumor groups,” said Dr. Wood.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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