Palliative care screening tools in the gynecologic oncology population: a narrative review

Abstract

Background and Objective: Patients with gynecologic malignancies experience high symptom burden associated with both their disease and sequelae of treatment, and are at risk for aggressive (and often futile) care at end-of-life. Early palliative care (PC) involvement is essential to improving quality of life in this population of patients through symptom management and advanced care planning discussions. The purpose of this review article is to discuss current PC screening tools used to trigger PC consultations for patients with gynecologic malignancies. PC screening tools are reviewed across both inpatient and outpatient clinical settings. Methods: A literature search was conducted utilizing PubMed® and Excerpta Medica database (EMBASE®). Search terms included various combinations of palliative care, gynecologic oncology, gynecologic cancer, gynecologic malignancy, female genital tract cancer, trigger, consult, referral, and screen. Key Content and Findings: A total of six PC referral methods for patients with gynecologic cancer were identified across 10 studies discovered in this literature search. PC referral tools reviewed included use of the surprise questions, presence of specific clinical triggers, Triggered Palliative Care Consultation (TPCC), Palliative Care Referral Protocol (PCRP), Patient Reported Outcomes Measurement Information System (PROMIS), and Symptom screening with Targeted Early Palliative care (STEP). Conclusions: Despite increased interest in PC screening tools to prompt earlier referral for patients with gynecologic cancers, this topic has limited research with varying results of PC referral. While some screening tools reviewed appear promising, further research targeting patients with gynecologic cancer across treatments settings is warranted.