A Scoping Review on Triage for Palliative Care Patients Based on Priority Decision-making

doi:10.12114/j.issn.1007-9572.2024.0445

Abstract

Abstract:

Background

Palliative care, as an essential medical service to improve the quality of life for patients in advanced stages, relies on the rationality of tiered diagnosis and treatment as well as resource allocation, which directly impacts patients' medical experiences and outcomes. However, current research on priority decision-making for triaging palliative care patients remains fragmented both domestically and internationally, and there is still a lack of systematic summaries and standardized guidance tools.

Objective

This study aims to conduct a scoping review of domestic and international research on triage decisions for palliative care patients based on prioritization. The goal is to provide a reference for the development of assessment tools for graded referrals in palliative care and to inform future decisions regarding referral processes.

Methods

The methodology was based on the Joanna Briggs Institute's guidelines for scoping reviews. A comprehensive search was conducted in databases including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, and China Biomedical Literature Database. The search covered studies published from the inception of each database up until April 2024. Relevant studies were identified, summarized, and analyzed.

Results

A total of 13 studies were included. From these, three categories of influencing factors and six assessment tools were identified. The influencing factors in palliative care triage include the severity and stability of the disease, patient and caregiver needs and preferences, and the availability and provision of medical resources. The assessment tools consider various factors such as symptoms, psychological aspects, caregiver needs, and care settings to categorize patients and determine their priority for accessing palliative care resources.

Conclusion

Graded diagnosis and treatment are crucial components of the palliative care system. It is essential to prioritize the development and refinement of triage concepts related to palliative care. Under this guidance, standardized and unified assessment tools or criteria should be established to match medical resources with patient needs. This will ensure that patients are referred to appropriate levels of palliative care institutions based on priority, thereby promoting the effective implementation of graded diagnosis and treatment policies and ensuring the rational use of resources.

Key words: Palliative care, Hierarchical diagnosis and treatment, Priority, Resource allocation, Scoping review

摘要：

背景

安宁疗护作为改善疾病晚期患者生活质量的重要医疗服务，其分级诊疗和资源分配的合理性直接影响患者的医疗体验和结局。然而目前国内外针对安宁疗护患者分诊的优先级决策研究较为分散，尚缺乏系统性总结和规范化指导工具。

目的

对国内外基于优先级决策的安宁疗护分诊相关研究进行范围综述，为今后安宁疗护分级转诊评估工具开发以及开展转诊决策提供参考。

方法

以乔安娜布里格斯研究所范围综述指南为方法学框架，检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库中的相关研究，检索时限为建库至2024年4月，对纳入文献进行汇总和分析。

结果

最终纳入13篇文献，经提取后共总结出3类影响因素，6种评估工具。安宁疗护分诊影响因素包括疾病严重程度及稳定性、患者及照顾者需求和偏好、医疗资源支持与供给。评估工具针对不同场所，综合考虑症状、心理、照顾者因素、护理需求、护理地点等因素，决定患者获取安宁疗护资源的优先级。

结论

分级诊疗是安宁疗护体系的重要组成部分，应重视安宁疗护分级诊疗优先级相关理念的发展和完善，并在其指导下构建规范统一的评价工具或标准，将医疗资源与疾病诉求相匹配，将患者按照优先级转诊到各等级安宁疗护机构，保证资源合理利用，促进分级诊疗政策落地。

关键词: 安宁疗护, 分级诊疗, 优先级, 资源分配, 范围综述

LIU Yahui,XU Yanan,YUAN Ling, et al. A Scoping Review on Triage for Palliative Care Patients Based on Priority Decision-making[J]. Chinese General Practice, 2026, 29(24): 3538-3544. DOI: 10.12114/j.issn.1007-9572.2024.0445.
刘雅慧,徐雅楠,袁玲等. 基于优先级决策的安宁疗护患者分诊研究范围综述[J]. 中国全科医学, 2026, 29(24): 3538-3544. DOI: 10.12114/j.issn.1007-9572.2024.0445.

Figures/Tables 4

References 49

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步骤	检索式
#1	"Hospice Care"[Mesh]
#2	"Palliative Care"[Title/Abstract] O R "Terminal Care"[Title/Abstract] O R"Hospice Care"[Title/Abstract] O R "Hospice Nursing"[Title/Abstract] O R "Palliative Nursing"[Title/Abstract] O R "End of Life"[Title/Abstract]
#3	#1O R #2
#4	priority[Title/Abstract] O R grade[Title/Abstract] O R Urgency[Title/Abstract] O R Primacy[Title/Abstract]
#5	Referral[Title/Abstract] O R refer[Title/Abstract] O R "Transfer treatment"[Title/Abstract] O R Triage[Title/Abstract] O R shunt[Title/Abstract]
#6	#3 AND #4 AND #5

步骤	检索式
#1	"Hospice Care"[Mesh]
#2	"Palliative Care"[Title/Abstract] O R "Terminal Care"[Title/Abstract] O R"Hospice Care"[Title/Abstract] O R "Hospice Nursing"[Title/Abstract] O R "Palliative Nursing"[Title/Abstract] O R "End of Life"[Title/Abstract]
#3	#1O R #2
#4	priority[Title/Abstract] O R grade[Title/Abstract] O R Urgency[Title/Abstract] O R Primacy[Title/Abstract]
#5	Referral[Title/Abstract] O R refer[Title/Abstract] O R "Transfer treatment"[Title/Abstract] O R Triage[Title/Abstract] O R shunt[Title/Abstract]
#6	#3 AND #4 AND #5

第一作者	发表时间（年）	国家	研究主题	影响因素
Russell^[13]	2018	澳大利亚	安宁疗护服务分诊工具开发	身体痛苦、心理痛苦、照顾者痛苦、紧急沟通或信息需求、护理需求和护理安排之间的差异、护理地点和期望的护理地点之间的不匹配、即将死亡
Bull^[14]	2017	美国	基于社区的安宁疗护入院优先级评估工具的构建	近期护理环境改变、症状严重程度、功能状态、药物数量和药物变化、营养状况、近期感染
Newpo r t^[15]	2014	美国	住院安宁疗护咨询跨学科分诊的简单工具	患者疾病阶段稳定性、症状严重程度、入院原因
Duraisamy^[16]	2011	印度	家庭安宁疗护病房的分诊系统	症状严重程度、心理困扰、社会困扰、精神痛苦
Glajchen^[17]	2011	美国	美国急诊科安宁疗护转入病人快速筛查方案	日常生活活动（ADL）、症状严重程度、功能状态、照顾者负担水平
Philip^[18]	2010	澳大利亚	住院安宁疗护分诊工具的开发与评价	患者疾病阶段稳定性、症状严重程度、预期生存期、心理社会困扰、照护场所的适宜性评估
Fergus^[19]	2008	英国	专科安宁疗护住院部的患者进行分诊	疼痛、其他症状、家庭焦虑、精神困扰、护理环境
Eagle^[20]	2005	英国	安宁疗护住院患者入院决策程序探讨	患者疾病阶段稳定性、症状严重程度、入院前所在地、入院原因、患者需求
Macdonald^[21]	1995	美国	基于价值的临终关怀入院分诊方法	转介个案准备入院的时间长度、症状的严重程度、家庭压力水平、对安宁疗护机构产生影响的程度

第一作者	发表时间（年）	国家	研究主题	影响因素
Russell^[13]	2018	澳大利亚	安宁疗护服务分诊工具开发	身体痛苦、心理痛苦、照顾者痛苦、紧急沟通或信息需求、护理需求和护理安排之间的差异、护理地点和期望的护理地点之间的不匹配、即将死亡
Bull^[14]	2017	美国	基于社区的安宁疗护入院优先级评估工具的构建	近期护理环境改变、症状严重程度、功能状态、药物数量和药物变化、营养状况、近期感染
Newpo r t^[15]	2014	美国	住院安宁疗护咨询跨学科分诊的简单工具	患者疾病阶段稳定性、症状严重程度、入院原因
Duraisamy^[16]	2011	印度	家庭安宁疗护病房的分诊系统	症状严重程度、心理困扰、社会困扰、精神痛苦
Glajchen^[17]	2011	美国	美国急诊科安宁疗护转入病人快速筛查方案	日常生活活动（ADL）、症状严重程度、功能状态、照顾者负担水平
Philip^[18]	2010	澳大利亚	住院安宁疗护分诊工具的开发与评价	患者疾病阶段稳定性、症状严重程度、预期生存期、心理社会困扰、照护场所的适宜性评估
Fergus^[19]	2008	英国	专科安宁疗护住院部的患者进行分诊	疼痛、其他症状、家庭焦虑、精神困扰、护理环境
Eagle^[20]	2005	英国	安宁疗护住院患者入院决策程序探讨	患者疾病阶段稳定性、症状严重程度、入院前所在地、入院原因、患者需求
Macdonald^[21]	1995	美国	基于价值的临终关怀入院分诊方法	转介个案准备入院的时间长度、症状的严重程度、家庭压力水平、对安宁疗护机构产生影响的程度

第一作者	发表时间（年）	国家	研究主题	评估工具	评估内容	使用方式
Paiva^[22]	2022	巴西	晚期癌症患者急诊安宁疗护的分诊	急诊环境下的安宁疗护分诊系统（PCTS）	每一级别均有对应的分诊标准，主要包括各种疾病症状指标如KPS、意识、疼痛、体温等，此外还有患者精神状态及照顾者需求	PCTS采用4级分诊，以不同颜色进行区分，按紧急程度由重到轻分别是红色、黄色、绿色、蓝色，分别要求≤15 min、≤30 min、≤1 h、≤2 h接诊
Russell^[12]	2020	澳大利亚	终末期疾病患者的安宁疗护入院优先级评估	安宁疗护急需分诊工具（RUN-PC）	患者的身体痛苦；患者的心理或精神痛苦；照顾者的痛苦；患者或照顾者的紧急和复杂的沟通或信息需求；护理需求与护理安排之间的差异；当前护理地点与患者或照顾者所需的护理地点不匹配；患者即将死亡	由专业分诊人员（接受过培训的医生、护士）分诊；总分0~100分，分为常规、非紧急、紧急、危急4级，向社区或者住院环境转介，来评估和比较新转诊患者在分配住院床位或安排社区访问时的紧迫性
Dhiliwal^[23]	2016	印度	采用埃德蒙顿症状评估量表（ESAS）对在家庭安宁疗护中的应用	ESAS	评估疼痛、乏力、呼吸困难、食欲、抑郁、焦虑等各种不适症状	对于埃德蒙顿症状评估量表中1种或多种症状得分>7分的患者，分配高优先级，将在1~3个工作日内由家庭护理团队就诊；得分为4~6分的患者，分配中等优先级，将在10个工作日内由家庭护理团队就诊；得分在0~3分的患者，分配低优先级，将在15个工作日内由家庭护理团队就诊
Tan^[24]	2012	澳大利亚	社区安宁疗护入院优先级评估工具的构建	社区安宁疗护服务分诊工具	评估指标主要包括疾病状态、疼痛、其他不稳定或不受控制的症状、心理社会困扰、认知和其他问题（如日常护理需求）	根据得分分为3个等级，A（得分≥10分）、B（得分6~9分）、C（得分<6分），要求分别在24 h，2~5 d，6~10 d内转诊至合适的安宁疗护场所
Philip^[18]	2010	澳大利亚	住院安宁疗护患者优先级评估工具	住院安宁疗护入院分诊工具（IPAT）	评估条目包括预后、身体症状、心理社会困扰、疾病阶段、护理环境5个维度	根据IPAT工具计算出的入院分数，按敏锐度对入院患者进行优先排序；随着临床状况的变化或每周更新等待名单上的患者的分数
Macdonald^[21]	1995	美国	基于价值观的临终关怀入院分诊方法研究	SARP安宁疗护入院优先级评估工具	"seniority"是指转介个案准备入院的时间长度，以转介后所经过的时间来衡量安宁疗护资格。"acuity"指的是患者症状的相对严重程度；"risk"指的是目前明显的家庭压力水平，或者是对患者安全和福祉的威胁的严重程度；"political significance"指的是如果某一特定患者没有得到优先关注，对安宁疗护机构产生负面影响的程度	4项标准中的每一项被赋予1~3的数值，3代表最强或最严重；这4个值加在一起就是SARP得分，SARP得分最低为4分，最高为12分；SARP得分最高的患者会被优先安排合适的医疗机构