Triggers Toolkit - for Staff

What is a Triggers Service and what are its aims?

A Triggers Service is:

  • Collaborative relationship between oncology and Symptom Control and Palliative Care teams (SCPCT)
  • Adopting co-productive strategies to shape service delivery
  • Early identification of patient need using the Triggers Tool

Our Aims are

  • To improve patients symptom burden at the start of their journey
  • Access to Advance Care Planning
  • Demystifying SCPC to our patients

The Triggers Tool 

The Triggers Tool is a simple tool, devised by palliative care experts and can help identify patients attending clinic who may benefit from earlier introduction to SCPCT:
  • Symptoms not present - TRIGGERS NEGATIVE - No intervention required 
  • One or more symptoms present - TRIGGERS POSITIVE - Triggering:- Service introduction, Holistic needs assessment Intervention, Future review

Metastatic cancer progressing after 1st line treatment: 

  • Performance status ECOG2 and deteriorating 
  • Acute oncology or unplanned admission 
  • Severe of overwhelming symptoms 
  • Anorexia, hypercalaemia, or any effusion 
  • Moderate or severe psychological or existential distress 
  • Complex social issues 

How would the service operate in clinic?

What happens after a review? 

  • The service will carry out a holistic needs assessment and discuss what is most important to you.
  • If any medications are suggested, we discuss with your oncology team first and document it in your medical notes
  • We will contact you again, either by phone or when you next attend clinic and check if there has been an improvement in your symptoms.
  • The Triggers Service will continue to review, until your symptoms have resolved
  • The Triggers Service will also discuss patients in our Triggers MDT (oncology staff are invited to attend) and document this on the patient record any further recommendations to management of symptoms
  • Take a step back when symptoms have resolved
  • Discuss future planning with the medical oncology team 

How would you inform your patient population about the service? 

Information about the Triggers service should be provided within the very first letter inviting the patient to attend clinic. When attending outpatient clinics, patients and their families should be able to see posters depicting the service and pamphlets should be made available explaining what the service offers 
 
Introduce our service to your patients at the very first review as part of your medical/nursing review. Educate your patient population of integrative working practices and providing access for your patient group to expert symptom control advice and information 

When is the right time to introduce the Triggers service? 

At the very start of the patient journey. Working collaboratively with oncology teams to ensure that their patients get access to: 
  • The right support
  • At the right time 
  • In the right place 
  • By the right people 

What would oncology and SCPCTs need to consider before adopting this service?

To create a Triggers Service it is important to note that change to service delivery takes time.  Oncology and SCPCT would need to examine barriers that may impact on creating this service.  These may include:-
Existing resources (manpower) and if existing resources could adopt the service
 
What additional resources you would need to adopt the service (i.e manpower, training). Identify barriers that may impact on creating a Triggers service (i.e relationship between teams). Listen to all opinions from teams – they are the experts and may have identified potential solutions to barriers

How would you measure Triggers service impact? Data, service design and outcome