GP Update

A new model of palliative care: symptoms trigger service

There is evidence that early intervention with palliative care is beneficial for advanced cancer patients. Find out about a new model of palliative care being trialled at The Royal Marsden.

Doctor with a patient

The benefits of early intervention of palliative care for patients with advanced cancer include:

  • Improved quality of life
  • Reduced depression
  • Less aggressive care at end of life
  • Increased survival
  • Better symptom control and
  • Improved prognostic understanding.

The integrated palliative care model at The Royal Marsden is currently focusing on lung cancer patients. The model involves proactive palliative care for patients from diagnosis of cancer, using a ‘triggers’ tool. This individualised and holistic needs-based approach includes not just patients at end of life, but those living with and surviving cancer.

The triggers tool proactively identifies which patients may benefit from palliative care referral; palliative care team involvement alongside active anti-cancer therapy is then offered. Improved integration between hospital oncology and palliative care teams ensures timely access to the most appropriate care for each patient.

The patient is ‘trigger positive’ if they have any one of the following:

  • Metastatic cancer progressing after first line of treatment
  • Performance status ECOG 2 and deteriorating
  • Acute oncology or unplanned admission
  • Severe or overwhelming symptoms
  • Anorexia, hypercalcaemia or any effusion
  • Moderate or severe psychological or existential distress
  • Complex social issues

Trigger positive patients meet with a Specialist Palliative Care Nurse for assessment of palliative care needs, and to provide information to them about palliative care in hospital and the community, and about advance care planning. Onward referral is based on the trigger outcome, IPOS (Integrated Palliative care Outcome Scale) assessment and discussion with the patient.

Between March 2017 and April 2018, 433 eligible new lung cancer patients were assessed and 62 per cent were ‘trigger positive’. Of these, 76 per cent had a WHO performance status of 0-1, demonstrating that patients can look well and be getting on with their lives, but can still have palliative care needs.

Funding has been approved for a research post to test the effectiveness of the trigger tool and to validate it.

A Darzi Fellow has been appointed to work externally with other Trusts and hospices, with the aim of extending the triggers service and standardising palliative care referrals.