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Use of a Novel Trigger Tool to Identify Palliative Care Needs in Surgical Patients at a National Referral Hospital in Kenya: A Pilot Study.

Publication ,  Journal Article
Li, HW; Saruni, SI; Carpenter, K; Chepkemoi, E; Ochieng, NA; Obanda, LN; Haskett, L; Cornetta, K; Brown, C; Korir, M; Keung, CH; Kussin, PS
Published in: J Palliat Med
September 2021

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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Published In

J Palliat Med

DOI

EISSN

1557-7740

Publication Date

September 2021

Volume

24

Issue

10

Start / End Page

1455 / 1460

Location

United States

Related Subject Headings

  • Referral and Consultation
  • Pilot Projects
  • Palliative Care
  • Kenya
  • Humans
  • Hospitals, Teaching
  • Gerontology
  • Adult
  • 4205 Nursing
  • 4203 Health services and systems
 

Citation

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Li, H. W., Saruni, S. I., Carpenter, K., Chepkemoi, E., Ochieng, N. A., Obanda, L. N., … Kussin, P. S. (2021). Use of a Novel Trigger Tool to Identify Palliative Care Needs in Surgical Patients at a National Referral Hospital in Kenya: A Pilot Study. J Palliat Med, 24(10), 1455–1460. https://doi.org/10.1089/jpm.2020.0669
Li, Helen W., Seno I. Saruni, Kyle Carpenter, Eunice Chepkemoi, Nancy Adhiambo Ochieng, Lorna N. Obanda, Lindsay Haskett, et al. “Use of a Novel Trigger Tool to Identify Palliative Care Needs in Surgical Patients at a National Referral Hospital in Kenya: A Pilot Study.J Palliat Med 24, no. 10 (September 2021): 1455–60. https://doi.org/10.1089/jpm.2020.0669.
Li HW, Saruni SI, Carpenter K, Chepkemoi E, Ochieng NA, Obanda LN, et al. Use of a Novel Trigger Tool to Identify Palliative Care Needs in Surgical Patients at a National Referral Hospital in Kenya: A Pilot Study. J Palliat Med. 2021 Sep;24(10):1455–60.
Li, Helen W., et al. “Use of a Novel Trigger Tool to Identify Palliative Care Needs in Surgical Patients at a National Referral Hospital in Kenya: A Pilot Study.J Palliat Med, vol. 24, no. 10, Sept. 2021, pp. 1455–60. Pubmed, doi:10.1089/jpm.2020.0669.
Li HW, Saruni SI, Carpenter K, Chepkemoi E, Ochieng NA, Obanda LN, Haskett L, Cornetta K, Brown C, Korir M, Keung CH, Kussin PS. Use of a Novel Trigger Tool to Identify Palliative Care Needs in Surgical Patients at a National Referral Hospital in Kenya: A Pilot Study. J Palliat Med. 2021 Sep;24(10):1455–1460.
Journal cover image

Published In

J Palliat Med

DOI

EISSN

1557-7740

Publication Date

September 2021

Volume

24

Issue

10

Start / End Page

1455 / 1460

Location

United States

Related Subject Headings

  • Referral and Consultation
  • Pilot Projects
  • Palliative Care
  • Kenya
  • Humans
  • Hospitals, Teaching
  • Gerontology
  • Adult
  • 4205 Nursing
  • 4203 Health services and systems