This preprint is under consideration at Supportive Care in Cancer. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Yashna Nadkarni
Royal Marsden Hospital NHS Trust: Royal Marsden NHS Foundation Trust
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Introduction
Palliative care within Intensive Care Units (ICU) benefits decision making, symptom control and end-of-life care. It has shown to reduce length of ICU stay and the use of non-beneficial and unwanted life-sustaining therapies. However, it is often initiated late or not at all. There is increasing evidence behind screening ICU patients using certain criteria or “triggers”.
The aim of the project was to assess the need for palliative care referral during ICU admission using “Trigger” tools.
Methods
Electronic patient record review of cancer patients who died in or within 30 days of discharge from oncology ICU 2016-18.
Patients referred to palliative care prior to or during ICU admission were identified. Three sets of palliative care referral “triggers” were applied: one that is being tested locally and two internationally derived tools. The proportion of patients who met any of these triggers during their final ICU admission was calculated.
Results
Patients included:149. Median age: 65 years (range 20-83).
Unplanned ICU admissions: 89%.
Most common diagnoses: Haemato-oncology (32%); gastrointestinal cancer (22%).
Patients not known to palliative care team before ICU admission: 73%
Patients referred to palliative care from ICU admission to death: 44%
The overall median time (range) between palliative care referral and death: 0 (0-19) days.
97% to 99% patients warranted referral to palliative care on admission to ICU, using the internationally and locally derived trigger tools.
Conclusion
All “Triggers” tools identified a high proportion of patients who may have benefitted from palliative care referral on admission to ICU.
Keywords
Trigger Tools, Palliative Care, ICU, Referral Criteria, End of Life
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This preprint is under consideration at Supportive Care in Cancer. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Yashna Nadkarni
Royal Marsden Hospital NHS Trust: Royal Marsden NHS Foundation Trust
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 26 Apr, 2021
No community comments so far
Reviewers invited
Invitations sent on 04 May, 2021
First submitted
On 07 Mar, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Policy
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Introduction
Palliative care within Intensive Care Units (ICU) benefits decision making, symptom control and end-of-life care. It has shown to reduce length of ICU stay and the use of non-beneficial and unwanted life-sustaining therapies. However, it is often initiated late or not at all. There is increasing evidence behind screening ICU patients using certain criteria or “triggers”.
The aim of the project was to assess the need for palliative care referral during ICU admission using “Trigger” tools.
Methods
Electronic patient record review of cancer patients who died in or within 30 days of discharge from oncology ICU 2016-18.
Patients referred to palliative care prior to or during ICU admission were identified. Three sets of palliative care referral “triggers” were applied: one that is being tested locally and two internationally derived tools. The proportion of patients who met any of these triggers during their final ICU admission was calculated.
Results
Patients included:149. Median age: 65 years (range 20-83).
Unplanned ICU admissions: 89%.
Most common diagnoses: Haemato-oncology (32%); gastrointestinal cancer (22%).
Patients not known to palliative care team before ICU admission: 73%
Patients referred to palliative care from ICU admission to death: 44%
The overall median time (range) between palliative care referral and death: 0 (0-19) days.
97% to 99% patients warranted referral to palliative care on admission to ICU, using the internationally and locally derived trigger tools.
Conclusion
All “Triggers” tools identified a high proportion of patients who may have benefitted from palliative care referral on admission to ICU.
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