The Impact of a Novel Tool for Comprehensive Assessment of Palliative Care (MPCAT) on Assessment Outcome at 6- and 12-Month Follow-Up

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• 作者：Martina O'Reilly ; BSc ; OT (Hons) ; PhD (C)^a ; ^{m.oreilly@milfordcarecentre.ie" class="auth_mail" title="E-mail the corresponding author} ; Philip Larkin ; BSc (Hons) ; MSc ; PhD ; RN ; RCN ; RHV ; RNT^b ; Marian Conroy ; MB ; FRCP^a ; Feargal Twomey ; MB ; MRCPI^a ; Micheal Lucey ; MB ; BMedSci ; FRCPI ; MBA^a ; Colum Dunne ; BSc (Hons) ; PhD ; MBA^c ; David J. Meagher ; MD ; PhD ; MRCPsych^c
• 关键词：Palliative care ; assessment ; pain ; physical ; psychological ; spirituality
• 刊名：Journal of Pain and Symptom Management
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：52
• 期：1
• 页码：107-116
• 全文大小：197 K

文摘

Assessment in palliative care settings should be focused, sensitive, specific, and effective to minimize discomfort to vulnerable and often highly morbid patients. This report describes the development of an admission assessment protocol for a Specialist Palliative Care Inpatient Unit and its implementation into clinical practice.

Objectives

The aim of this study was to develop and investigate the impact of the implementation of a Specialist Palliative Care admission assessment tool on documentation of key patient needs.

Methods

The outcome of a systematic literature review was used to develop an admission assessment protocol (the intervention) in a Specialist Palliative Care Inpatient Unit. Mixed methods were used to facilitate a comprehensive evaluation pre- and post-intervention to test the effectiveness, feasibility, and acceptability of the intervention.

Results

The documented evidence of pain assessment improved from a baseline rate of 71% to 100% post-intervention. This improvement was maintained 12 months post-introduction of the tool (P < 0.001). The documented evidence of screening for spiritual distress increased from a baseline rate of 23% to 70% at 6 months and to 82% at 12 months (P < 0.001). The number of referrals made in the first 24 hours after assessment increased post-intervention (physiotherapy, P = 0.001; occupational therapy, P = 0.001; social work, P = 0.005; pastoral care, P = 0.005); this was maintained at 12 months. Significantly, more clinicians (88%) agreed that palliative care domains were comprehensively assessed post-intervention in comparison with 59% pre-intervention (P = 0.01).

Conclusion

Introducing the Milford Palliative Care Assessment Tool was associated with significant improvement in assessment of multiple important aspects of patient need.