PURPOSE Benefits of early palliative referral in oncology are well documented. Palliative care referral "triggers" may help identify patients for referral. Many triggers have been proposed, but are not commonly used. This study reviewed the timing of palliative care involvement for patients in a tertiary referral oncology hospital, and whether the use of a trigger tool prior to admission would have facilitated earlier referral. METHODS This was a retrospective cohort study of cancer patients who died during an unplanned admission between November 2014 and October 2015. A literature review identified seven palliative care referral tools which were included in this analysis, and compared by identifying common themes. Each tool was applied to patients by reviewing electronic patient records. Timing of palliative referral and whether patients met any triggers within 6 months before their terminal admission were assessed. RESULTS A total of 159 patients were identified. Forty-six percent were referred to palliative care prior to terminal admission. Application of 6 out of 7 trigger tools would have resulted in the majority of patients (up to 91.2%) referred to palliative care prior to admission. Most patients (52.2%) were referred only during their terminal admission. Patients known to palliative care before admission (N = 73) were reviewed quicker than those who were not (N = 86) (median (range) 1 day (0-23 days) versus 5 days (0-59 days), p < 0.00001). CONCLUSIONS In this patient cohort, a palliative referral trigger tool may have proactively identified most patients prior to their terminal admission. Prospective testing of trigger tools in oncology populations is warranted.

中文翻译：

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对于癌症患者的早期姑息治疗转诊的“触发器”：对紧急计划外入院和结局的回顾。

目的肿瘤治疗中早期姑息性转诊的益处已得到充分证明。姑息治疗转诊“触发器”可能有助于识别要转诊的患者。已经提出了许多触发器，但是并不常用。这项研究回顾了三级转诊肿瘤医院对患者进行姑息治疗的时机，以及入院前使用触发工具是否会促进较早转诊。方法这是一项针对2014年11月至2015年10月在计划外入院期间死亡的癌症患者的回顾性队列研究。文献综述确定了包括在该分析中的七种姑息治疗转诊工具，并通过确定共同主题进行了比较。通过查看电子患者记录，将每种工具应用于患者。评估姑息转诊的时间以及患者入院前6个月内是否遇到任何触发因素。结果共鉴定出159例患者。46％的患者在入院前接受了姑息治疗。使用7种触发工具中的6种将导致大多数患者（入院前）接受姑息治疗（高达91.2％）。大多数患者（52.2％）仅在末次入院时才转诊。入院前已知为姑息治疗的患者（N = 73）比未接受治疗的患者（N = 86）（中位（范围））1天（0-23天）对5天（0-59天）的复查速度更快，p < 0.00001）。结论在该患者队列中，姑息性转诊触发工具可能在大多数患者入院前已主动识别出患者。