Development of a risk classification protocol for cancer patients in Home-based Palliative Care

Abstract

Home-based Palliative Care services specialized in the treatment of cancer patients aim to identify and  control physical, psychosocial, and spiritual symptoms at home. Some challenges encountered are the  complexity of symptoms, reduced survival of patients  with advanced cancer, and limitations of the health  care system. To stratify the priority of care for patients with advanced cancer in home Palliative Care, a risk  classification protocol was developed. This article is an experience report on the process of creating a risk  classification protocol for patients with advanced  cancer treated at a home Palliative Care service in Rio  de Janeiro. The initial stage involved meetings of the  home care team at an oncology hospital and  structured searches in the literature. Afterwards, the  clinical situations of more complex management at  home were listed and named as warning signs and  symptoms: pain, shortness of breath, nausea/vomiting, bleeding, and acute mental  confusion. An assessment and triage protocol was  developed with five categories/colors to determine  the priority of patient care. The developed triage  system has easy applicability and requires a brief  training of the health professional so that it can be  used during home visits.