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Supportive and palliative care

2923 - Proactive Referral to Palliative Care: Model of a new Integrated Palliative Care and Oncology Service


09 Sep 2017


Supportive and palliative care


End-of-life Care


Jayne Wood


Annals of Oncology (2017) 28 (suppl_5): v605-v649. 10.1093/annonc/mdx440


J. Wood1, A. Stevens1, Y. Kano1, J. Nevin1, S. Popat2, T. Wiseman3, J. Droney1

Author affiliations

  • 1 Symptom Control And Palliative Medicine, Royal Marsden Hospital NHS Foundation Trust, SW3 6JJ - London/GB
  • 2 Medical Oncology, Royal Marsden Hospital, SW3 6JJ - London/GB
  • 3 Applied Health Research, Royal Marsden Hospital NHS Foundation Trust, SW3 6JJ - London/GB


Abstract 2923


There is clear evidence supporting the benefits of early palliative care (PC) for patients with cancer. Despite this, referrals to PC tend to be late and are focused mainly on End of Life Care. This project involves evaluation of a new integrated service between oncology and PC teams. The aim of this service is to normalise early PC alongside active oncology treatment and to ensure that PC is available to all cancer patients with PC needs. This service is based on the introduction of a brief “Triggers” tool to help oncologists accurately identify patients who should be referred to PC. This “Triggers Tool” includes 7 disease and patient-specific indicators of progressive disease and PC need.


Study population: New patients attending the lung oncology outpatient clinics. Prospective longitudinal observational service evaluation. Objectives: To determine the integrated PC service review rate in eligible patients To describe the PC needs of patients reviewed by Triggers team Patients are scored using the “Triggers” Tool and categorised into “Trigger positive” and “Trigger negative” cohorts. Patient reported outcome measures and assessments of PC need are completed using validated tools (IPOS Integrated Palliative Outcome Scale, Phase, Performance status (PS)). Participants are followed up longitudinally and assessments are repeated at different time points.


In the first 4 months of the new service, 84% (97/115) of eligible patients were reviewed by the Integrated PC service within 2 months of the 1st outpatient clinic attendance. 75% (73/97) of patients reviewed scored positive on one or more of the Trigger tool items. The PC needs of “Trigger positive” patients, as defined by IPOS, were assessed in 70/73 eligible patients: 97% (68/70) patients had at least moderate PC need on at least one IPOS item. 81% (57/70) had severe or overwhelming PC need. 81% (57/70) of patients were PS 0-1.


Initial data suggest that the Integrated PC service is feasible and identifies patients with PC needs who would benefit from early PC referral. This service evaluation will be continued for 12 months which will facilitate analysis of other patient outcomes e.g. time between PC referral and death.

Clinical trial identification

Not applicable as this is a service evaluation

Legal entity responsible for the study

Royal Marsden Hospital




All authors have declared no conflicts of interest.

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