Background: The National Comprehensive Cancer Network Palliative Care (PC) Guideline recommends screening all oncology patients for PC needs, and to call a PC consult when referral criteria are met. There are no data on the feasibility or impact of this approach. The aim of this pilot study was to assess the feasibility of PC screening in patients admitted to a comprehensive cancer center (CCC). Methods: Design: Observational study. From 11/1/10 to 1/31/11, floor nurses screened all patients the day after admission under the two teams (“Team A” and “Team B”) of the Gastrointestinal Oncology Service at Memorial Sloan-Kettering Cancer Center. Team A patients were also evaluated by the referral criteria. Endpoints: Patients screened ‘positive’ if they had advanced disease and any of the clinical situations nominated in the Guideline. The referral criteria triggered PC consults in Team A patients; clinical judgment triggered Team B consults. Outcomes: Screening rates, nursing satisfaction survey, clinical and operational metrics. Results: Ninety percent (229 of 254) of admissions were screened. Both Teams’ patients were seriously ill (see Table), and it was no surprise that 63% (145 of 229) screened positive. Survey respondents (response rate 50%) rated screening as simple, quick and helpful, although nurses scored the extent of disease wrong in 16%. Sixty eight percent (55 of 780) of Team A patients who screened positive met the referral criteria. This generated more consults on Team A, but the effect on key outcomes was not significant (n.s.). Conclusions: Screening for PC was feasible in this setting, but is a challenging concept in terms of reliability, validity and timing. The value to a CCC of increasing PC access via referral criteria needs evaluation in well-designed trials.

Screened patients	Team A (n=113)	Team B (n=116)	p value
Status on admission
Time since diagnosis (months)	13	15	n.s.
Advanced disease	92%	97%	n.s.
Best supportive care	36%	39%	n.s.
Died within next 3 months	33%	45%	n.s.
Pain score ≥ 7/10	33%	34%	n.s.
Screen positive	71%	56%	0.028
Outcomes
Consults	42%	15%	<0.0001
Pain score ≥ 7/10, day 4*	13%	38%	n.s
Median length of stay (days)	4	4	n.s.
Died in hospital	4%	7%	n.s.
Hospice referral	19%	21%	n.s.
≤3 days on hospice	1%	3%	n.s.

*incomplete data