From aPain & Palliative Care Service, Department of Medicine; bDepartment of Nursing; and cDepartment of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
J Natl Compr Canc Netw. 2013 Sep 1;11(9):1087-96. doi: 10.6004/jnccn.2013.0130.
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Palliative Care recommend screening all patients for palliative care (PC) needs and to call a PC consult when referral criteria are met. The goal of this pilot project was to evaluate the feasibility of implementing the screening and referral components of the NCCN Guidelines for Palliative Care in patients admitted to the Gastrointestinal Oncology Service (GIOS) at a comprehensive cancer center (CCC). Floor nurses performed the initial screening of all patients admitted to the 2 teams-Team A and Team B-of the GIOS on one floor of Memorial Hospital for 3 months. In addition, only the patients admitted to Team A were evaluated according to the referral criteria, triggering a PC consult if results were positive. Nurses were surveyed regarding satisfaction with and the acceptability of screening. During the study period, 229 (90%) total admissions were screened, with 169 (73%) having positive results. Of the Team A admissions, 72 (64%) met the referral criteria. More consults occurred for patients in Team A (47 vs 15; P=.001). In 30% of the referral criteria-triggered consults, the PC needs were manageable by the primary team. Nurses reported screening to be easy and quick (<5 minutes per patient) but only somewhat helpful. Being unfamiliar with many patients and families, floor nurses often felt unable to screen them accurately for some issues. In conclusion, screening was feasible, increasing access to PC, but accuracy and usefulness are concerns. With a consult indicated in 64% patients, yet with 30% being manageable by the primary team, the current criteria may be too sensitive for the inpatient environment of a CCC. More evaluation is needed before widespread implementation can be recommended.
美国国家综合癌症网络（NCCN）肿瘤学临床实践指南（NCCN 指南）推荐对所有患者进行姑息治疗（PC）需求筛查，并在符合转诊标准时呼叫 PC 咨询。该试点项目的目的是评估在综合癌症中心（CCC）的胃肠肿瘤服务（GIOS）中实施 NCCN 姑息治疗指南的筛查和转诊部分的可行性。3 个月内，纪念医院一层的 2 个 GIOS 团队（A 组和 B 组）的所有入院患者均由楼层护士进行初步筛查。此外，仅根据转诊标准评估 A 组入院患者，如果结果阳性，则触发 PC 咨询。对护士进行了有关筛查的满意度和可接受性的调查。在研究期间，对 229 名（90%）总入院患者进行了筛查，其中 169 名（73%）结果为阳性。在 A 组入院患者中，有 72 名（64%）符合转诊标准。A 组的咨询次数更多（47 比 15；P=.001）。在 30%的转诊标准触发的咨询中，PC 需求可由初级团队管理。护士报告说，筛查既简单又快速（每位患者不到 5 分钟），但只是有些帮助。由于对许多患者和家属不熟悉，楼层护士常常觉得无法准确筛查出某些问题。总之，筛查是可行的，可以增加获得 PC 的机会，但准确性和有用性令人担忧。在符合转诊标准的 64%患者中，有 30%的患者可由初级团队管理，目前的标准可能对 CCC 的住院环境过于敏感。在广泛推荐之前，需要进行更多的评估。
