Abstract
Background:
Addressing unmet palliative care needs in high-risk surgical patients in low- and middle-income countries must include innovative approaches to limitations in personnel and culturally acceptable assessment modalities.
Objectives:
We assessed the utility of a novel seven-item “Step-1” trigger tool in identifying surgical patients who may benefit from palliative care.
Design:
All adult patients (≥18 years) on general surgery, neurosurgery, and orthopedic surgery wards were enrolled over a four-month period.
Setting/Subjects:
This study took place at Moi Teaching and Referral Hospital (MTRH), one of two Kenyan national referral hospitals.
Measurements:
The “Step-1” trigger tool was administered, capturing provider estimates of prognosis, cancer history, social barriers, admission frequency, hospice history, symptom burden, and functional decline/wasting. A cut-point of ≥3 positive factors was selected, indicating a patient may benefit from palliative care.
Results:
A total of 411 patients were included for analysis. Twenty-five percent (n = 102) of patients had scores ≥3. The cut-point of ≥3 was significantly associated with identifying high-risk patients (HRP; χ2 = 32.3, p < 0.01), defined as those who died or were palliatively discharged, with a sensitivity and specificity of 63.9% and 78.9%, respectively. Survey questions with the highest overall impact included: “Would you be not surprised if the patient died within 12 months?,” “Are there uncontrolled symptoms?,” and “Is there functional decline/wasting?”
Conclusions:
This pilot study demonstrates that the “Step-One” trigger tool is a simple and effective method to identify HRP in resource-limited settings. Although this study identified three highly effective questions, the seven-question assessment is flexible and can be adapted to different settings.
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