Dr Beth Russell, Palliative Care Physician and Researcher, Centre for Palliative Care, Melbourne, Australia, (together with Associate Professor Jennifer Philip, Professor Peter Hudson, Associate Professor Vijaya Sundararajan, Associate Professor Brian Le, Associate Professor Caroline Brand, Ms Anna Collins and Dr Sara Vogrin).
It’s Friday afternoon and your palliative care service is almost at capacity. There is only one bed left to accept one more patient, or there is only time for one more home visit, but the phone has been running hot with new referrals …
A breathless woman deteriorating with heart failure who can no longer walk to the bathroom … An unconscious man imminently dying after a major stroke … A woman with metastatic cancer having severe pain … A man with high care needs whose spouse caregiver is not coping…
Which patient would you give your last bed or home visit to?
As demand for palliative care increases, palliative care clinicians face these difficult decisions frequently. Yet there has been very little research to develop a robust and fair system to triage palliative care needs, that is, to prioritise one person’s needs over another.
The concept of triage was first developed during the Napoleonic wars in the early 1800s, with many refinements since. Today, there are simple, well tested tools for emergency clinicians to rate the severity of a patient’s injuries and allocate clinical resources in such a way as to help as many patients as possible. Not so in palliative care. The treatment goals may be different – focusing on quality of life and relief of suffering – but resources still need to be used in an equitable, transparent manner to achieve the greatest good.
To address this urgent need, our team has been working on developing a decision aid for palliative care triage. We have conducted a foundational study with Australian health professionals to better understand which factors clinicians use to assess the urgency of palliative care needs.1 Now we are using this as the basis for an international research project to determine how each of these factors should be weighted. We will use the research project results to create a decision aid for clinicians to use in everyday practice.
So, if you are a health professional anywhere in the world working primarily in palliative care with at least two years of experience, we want to know your views! Please take part in this world-first international online research project at www.tinyurl.com/palliativetriage. For more information email Dr Beth Russell or contact via the links below.
Thank you in advance for your important contribution to this work, which we hope will make palliative care more accessible to those who need it most.
1. Russell B, Hennesy-Anderson N, Collins A, Burchell J, Sundararajan V, Le B, Brand C, Hudson P, Philip J. Responding to urgency of need in palliative care: Initial stages in the development of a decision aid for palliative care triage. Palliative Medicine.2016; 30(6): NP42.