Responding to urgency of need: Initial qualitative stage in the development of a triage tool for use in palliative care services

Abstract

Background: Palliative care services face the challenge of a workload increasing in volume and diversity. An evidence-based triage method to assess urgency of palliative care needs is required to ensure equitable, efficient and transparent allocation of specialist resources when managing waiting lists. Aim: As the initial stage of a mixed-method sequential design, this study aimed to explore palliative care providers’ practices and attitudes towards triaging palliative care needs and their views regarding the implementation of a standardised approach. Design: A qualitative study was conducted involving focus groups and interviews. Transcripts were subjected to deductive thematic analysis. Setting/Participants: A total of 20 palliative care providers were purposively sampled to ensure representation across disciplines (primary, specialist; medicine, nursing and allied health), service types (inpatient, hospital liaison and community) and locations (metropolitan and rural). Results: A series of markers of urgency were identified, including physical and psychological suffering, caregiver distress, discrepancy between care needs and care arrangements, mismatch between current site of care and desired site of death when in terminal phase and complex communication needs. Performance status and phase of disease were reported to be less informative when considered in isolation. Interpersonal and system-based barriers to the implementation of a palliative care triage tool were highlighted. Conclusion: The process of triage in the palliative care setting is complex but can be conceptualised using a limited number of domains. Further research is required to establish the relative value clinicians attribute to these domains and thus inform the development of an acceptable and useful evidence-based palliative care triage tool.