Assessing the sensitivity and acceptability of the Royal Marsden Palliative Care Referral “Triggers” Tool for out-patients with cancer

Abstract Purpose: To evaluate the use, acceptability, and experience of a seven-item palliative care referral screening tool in an outpatient oncology setting. Methods: Atwo-phase convergent parallel mixed methods study. Patient participants who met any of the “Royal Marsden Triggers Tool” criteria were compared with those who did not in terms of demographic data, palliative care needs (Integrated Palliative Outcome Scale, IPOS) and quality of life indicators (EORTC-QLQ-C30). In-depth interviews were carried out with patients and oncology staff about their views and experience of the “Royal Marsden Triggers tool”. Qualitative and quantitative data were triangulated at data interpretation. Results: 348 patients were recruited to the quantitative phase of the study of whom 53% met at least one of the Triggers tool palliative care referral criteria. When compared with patients who were negative using the Triggers tool, “Royal Marsden Triggers tool” positive patients had a lower quality of life (EORTC QLQ-C30 Global Health Status scale (p<0.01)) and a higher proportion had severe or overwhelming physical needs on IPOS (38% versus 20%, p<0.001). Median survival of “Royal Marsden Triggers tool” positive patients was 11.7 months. 16 staff and 19 patients participated in qualitative interviews. The use of the tool normalized palliative care involvement, supporting individualized care and access to appropriate expertise. Conclusion The use of a palliative care referral tool streamlines palliative care within oncology outpatient services and supports teams working together to provide an early holistic patient-centered service. Further research is needed to evaluate the effectiveness and feasibility of this approach.