Telephone triage in palliative care: looking forward to move forward….

Sir,

I write this letter to Editor with the aim to reintroduce a recently evolving method of providing care as a sequel of Telemedicine and Telerehabilitation, the Telephone Triage (TT). TT is an integral part of palliative care that covers a broad range of activities, including symptom management, medication renewal, and coordination of care, education, and psychosocial support.[1]

Due to the complexity of clinical presentation and course of illness together with increasing healthcare demands from increasing prevalence and limited provider-based resources, cancer patients and their families often telephone their physician or cancer clinic to seek advice.[2] Also, when patient care shifts from inpatient to outpatient setting, there is need for oncology nurses to not only know about disease processes and clinical patient care but also be skilled in telephone nursing triage.[34]

Studies by de Carvalho et al.,[5] introduced telephone or email triage for physically impaired patients as part of lean practice in order to reduce unnecessary patient movement, after conducting a large qualitative survey of semi-structured interviews (a combination of closed and open-ended questions) among hospital nurses from oncological units in Spain.

Stananought and Sutherland[6] found that TT was an effective method in palliating symptoms when used as a component of Support Team Assessment Schedule (STAS) on 50 terminally ill patients. The adapted version of STAS tool was used to score patients, and the authors selected 50 patients randomly who scored 3 or above on STAS upon first contact telephone assessment. TT produced progressive reduction in STAS scores during second and third contact and also reduced waiting lists by providing a flexible, responsive high-quality specialist service appropriate-to-need, and streamlined symptom management.[7]

Strategies for TT

Gleason et al.,[8] performed an educational needs assessment of nurses to develop strategies for educating and improving telephone triage skills. The authors found that standardization of triage practice and improvement of triage effectiveness could enhance the nurse-patient relationship, effective continuity of care to the patient, reduce inappropriate appointments and hospitalizations, and reduce the risk of medical complications related to delays in care.

The utilization of easy-to-use, accessible yet nonrestrictive resources and a well-designed documentation tool along with standardization of telephone triage practices[9] can help guide the decision-making process in TT. These strategies were found to improve the pediatric oncological care by ensuring best possible patient care while addressing legal concerns.[10]

Issues in TT

The issues that require priority in TT are the nature and quality of information provided to patients, patients’ level of understanding and opportunity for clarification, comprehensive documentation of all processes and procedures including patient satisfaction-based outcomes along well-established guidelines; staff education and delineation of medical, nursing, and secretarial responsibilities; and adequacy of access to technical support systems. Adequate and appropriate TT would enable patients to receive quality information that allows them to manage symptoms at home, understand when medical interventions are necessary, and avoid unnecessary delays in care.[11]

It is then our right to utilize and study the utilization of TT in developing countries’ palliative care settings and move the reality of home-based palliative care one step forward.