The Royal Marsden pilots new Triggers tool for integrating palliative care

A new tool to identify patients who would benefit from early palliative care is being presented at the ESMO 2017 Congress

The Triggers tool, developed by the London Cancer Alliance to help clinicians in the UK recognise patients who need an early referral to specialist palliative care, has been successfully piloted at The Royal Marsden this year thanks to funding from The Royal Marsden Cancer Charity.

The preliminary results of the service evaluation to be presented at ESMO 2017 proves the usability of this tool by primary care teams and points to the feasibility of establishing the integrated service between oncology and palliative care teams on a wider scale. 

Palliative care has traditionally been associated with optimising the quality of life at the very end of life. However, research has shown that giving patients early access to specialist palliative care can have many benefits, including improving their prognosis.

The Triggers tool allows oncologists to assess their patients’ needs in this respect at a much earlier stage, and to potentially refer them to specialist palliative care alongside active treatment. In its pilot phase the tool was introduced for new patients at The Royal Marsden’s lung oncology outpatient clinic. In the first four months of the service, 84% of eligible patients were reviewed within two months of their first clinic attendance.

“We found that 75% of the patients reviewed triggered positive on one or more of the tool items,” says Dr Jayne Wood, Consultant in Palliative Medicine and Clinical Lead at The Royal Marsden (pictured), who led the evaluation.

“This tells us that we are addressing a real need, and that the tool is picking up a group of patients who have a real potential to benefit from referral to specialist palliative care. The goal is for the tool to become standard and easy for anyone on a patient’s primary care team to use – for us, the next step will be to expand into other tumour groups.”

Margaret Millihane, who was referred to The Royal Marsden after being diagnosed with lung cancer in April 2017, benefited from an early needs assessment via the tool.

Margaret said: “I was referred to the palliative care team around a fortnight after arriving at The Royal Marsden. They have helped me with medication, which has given me more energy, visited me at home, and have been able to advise me about different symptoms. I definitely feel that I can call them if I need them."

The Royal Marsden is one of ESMO’s Designated Centres of Integrated Oncology and Palliative Care, whose first accreditation dates back to 2009.

The accreditation programme recognises cancer centres that achieve a high standard of integration of medical oncology and palliative care, based on criteria ranging from service provision and integration to doctor credentials, research and education.