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The palliative care triage system in advanced cancer emergency care: development and initial validation
  1. Carlos Eduardo Paiva1,2,
  2. Fabíola de Lourdes Gonçalves de Freitas Seriaco3,
  3. Marco Antônio de Oliveira2,
  4. Maria Salete de Angelis Nascimento4 and
  5. Bianca Sakamoto Ribeiro Paiva2
  1. 1 Department of Clinical Oncology, Hospital de Câncer de Barretos, Barretos, Brazil
  2. 2 Palliative Care and Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, SP, Brazil
  3. 3 Palliative Care Outpatient Unit, Barretos Cancer Hospital, Barretos, SP, Brazil
  4. 4 Palliative Care Department, Barretos Cancer Hospital, Barretos, SP, Brazil
  1. Correspondence to Dr Carlos Eduardo Paiva, Department of Clinical Oncology, Hospital de Câncer de Barretos, Barretos, 14784-400, Brazil; caredupai{at}


Objective We aimed to develop and validate a new emergency triage tool for use on patients with cancer undergoing palliative care (PC).

Methods In phase I, the new tool was developed after literature review and expert committee meetings. A prospective longitudinal study in phase II assessed the interobserver reliability of the tool. In phase III, a retrospective study of administrative data, the feasibility of routine use of the new tool and the associations with hospitalisation and survival times were evaluated.

Results The palliative care triage system (PCTS) was composed of check-list items and four colour-coded categories for maximum response time. In phase II, the PCTS was independently evaluated by two nurses for 102 attendances in the emergency department of the PC unit. An absolute agreement of 87.3% and a weighted kappa of 0.81 were observed. In phase III, all 493 attendances had the PCTS assessment registered in the medical records. The PCTS categories were associated with hospital admission (p<0.001) and survival times (p<0.001).

Conclusion PCTS is a feasible tool to be used in routine ED triage of patients with advanced cancer undergoing PC. It is a valid instrument for predicting hospital admission rates and survival with high interobserver concordance rates.

  • cancer
  • hospital care
  • clinical decisions
  • clinical assessment

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  • Contributors Study design: CEP, FdLGdFS, MSdAN, BSRP. Manuscript draft and literature review: CEP, FdLGdFS. Data acquisition: FdLGdFS. Data analyses: CEP, FdLGdFS, MAdO. Manuscript preparation: CEP, FdLGdFS, MAdO, MSdAN, BSRP.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.