Paterson Pamela, Fairchild Alysa
Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada.
Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.
Tech Innov Patient Support Radiat Oncol. 2023 Jun 14;27:100213. doi: 10.1016/j.tipsro.2023.100213. eCollection 2023 Sep.
Patients who could benefit from palliative radiotherapy (PRT) may be in different phases of the cancer journey: they may have minimal symptoms and preserved functional status, or could be near end of life, with multiple complex care needs. Efficient triage at PRT referral is crucial to match patients with an appropriate provider and care setting as quickly as possible. Many centres have a dedicated PRT clinic, for which triage occurs by a Palliative Clinical Specialist Radiation Therapist (PCSRT). We performed an English-language literature search of 15 databases, without date limits, based on the PICO framework. After independent screening of titles and abstracts by two authors, relevant full text papers were reviewed. Twenty studies (15 publications and five abstracts) and one government report met inclusion criteria. Studies were published over a 21-year period by investigators from four countries. By identifying bottlenecks, screening out inappropriate referrals, and assessing patients in advance of consult, PSCRT triage decreased wait times by approximately 50%, on average, compared to standard pathways (range 30-82%). Increasing efficiency by pre-booking and coordinating appointments increases patient volumes and optimizes use of resources. A triage PCSRT serving a navigator role improves continuity of care, and in decreasing the number of handoffs, safety as well. Shifting triage to a PCSRT allows multidisciplinary team members to work to their maximum scope. In one clinic, after incorporation of PCSRT triage, use of on-call services decreased, as more patients were seen during daytime appointments, contributing to cost-savings.
可能从姑息性放疗（PRT）中获益的患者可能处于癌症病程的不同阶段：他们可能症状轻微且功能状态良好，或者可能接近生命末期，有多种复杂的护理需求。在PRT转诊时进行有效的分诊对于尽快为患者匹配合适的医疗服务提供者和护理环境至关重要。许多中心设有专门的PRT诊所，由姑息性临床专科放射治疗师（PCSRT）进行分诊。我们基于PICO框架对15个数据库进行了不限日期的英文文献检索。在两名作者独立筛选标题和摘要后，对相关全文论文进行了审查。二十项研究（15篇出版物和5篇摘要）以及一份政府报告符合纳入标准。这些研究是由来自四个国家的研究人员在21年期间发表的。通过识别瓶颈、筛选出不适当的转诊以及在会诊前对患者进行评估，与标准流程相比，PSCRT分诊平均将等待时间减少了约50%（范围为30 - 82%）。通过提前预约和协调预约来提高效率，可以增加患者数量并优化资源利用。担任导航员角色的分诊PCSRT可改善护理的连续性，并且在减少交接次数的同时也提高了安全性。将分诊工作转移给PCSRT可使多学科团队成员充分发挥其最大能力。在一家诊所，纳入PCSRT分诊后，随叫随到服务的使用减少，因为更多患者在日间预约就诊，从而节省了成本。
