The creation of a standardized screening tool successfully doubled rates of palliative care consult orders and helped identify palliative care needs that arose later in patient admission to the oncologic Intensive Care Unit (ICU), according to data presented by Erin Szymanski, DNP, APRN-CNP, M.Div., EBP-C, BCC, James Cancer Hospital, Columbus Ohio, at the Oncology Nursing Society (ONS) Annual Congress on April 25, 2024.

Szymanski and coauthors explained, “Patients admitted to the oncologic [ICU] face numerous challenges including complex comorbid conditions, symptom burden, financial strain, lengthy hospitalization, values conflicts, risk for readmission, and potential mortality despite aggressive interventions. Such difficulties can be exacerbated by underlying cancer diagnoses and complications secondary to cancer treatment. Palliative care aims to address these concerns.”

The authors noted that although national rates of palliative care referrals have been increasing among hospitalized patients overall, the rate specifically among ICU patients with cancer diagnoses has been decreasing. The primary goal of this project was to increase advance practice provider (APP) identification of patients with the greatest potential palliative care needs, which would subsequently increasing the number of orders for palliative care consult. The secondary stated goal was to increase acceptance of palliative care as a valuable intervention for oncology patients during ICU admission. 

For a 28-bed oncologic ICU, a standardized screening tool was created with collaborative input from APPs in order to identify key palliative care through a beginning implementation period of 4 weeks. Screening criteria were derived from the Center to Advance Palliative Care’s toolkit for improving palliative care in the ICU. The screening tool was utilized by APPs in daily rounds for all patients, helping to monitor and target palliative care needs as they developed over the course of a patient’s admission.

Using the tool, authors found that the rate of palliative care consults for patients in the oncologic ICU increased from 9.47% to 18.7%, when compared to the same 4-week time period from the year earlier. The average number of days from ICU admission to palliative care consult increased from 2.7 days during the control period to 4.6 days during the implementation period. These data demonstrate that the screening tool helped identify palliative care needs that arose later in the ICU admission when compared to pre-intervention.

Szymanski and coauthors concluded, “Palliative care has the potential to help manage many complex issues for patients in the oncologic ICU. By creating a standardized screening tool that was utilized by APPs during daily rounds, rates of palliative care consult orders doubled and palliative care needs were identified as they arose later in the ICU admission.”

“Utilizing a collaborative process in developing the tool was key to its successful adoption and implementation,” they added.

Source:

Szymanski E, Jun J, Tate J, et al. Standardized palliative care screening in the oncologic intensive care unit. Presented at Oncology Nursing Society Annual Congress. April 24-28, 2024; Washington, DC.