A pre-treatment nursing- and allied health (AH)-led screening and assessment service for medical oncology and haematology patients aged ≥ 70 years commenced at three Metro North Hospital and Health Service facilities in February 2018. Primary objectives were determining the feasibility and utility of formal geriatric screening and assessment for supportive care needs and identifying AH service impacts.
The Geriatric 8 (G8) screening tool is administered to predict patient vulnerability and need for comprehensive geriatric assessment (CGA). A bespoke CGA suite was adopted. A clinical nurse or AH practitioner conducts face-to-face or telephone screening, followed by face-to-face CGA. Proposed care is discussed and coordinated via multidisciplinary case conference. AH interventions are provided at two facilities.
To July 2018, the G8 was administered to 315 patients, comprising 73% (230) medical oncology, 24% (77) malignant haematology and 3% (8) non-malignant haematology patients.
187 patients (59%) showed impairment on G8 and were recommended for CGA. 61% (115) of recommended CGAs were conducted, comprising 36% of patients screened. Among other reasons, transport difficulties and patient reluctance mainly inhibited CGA uptake.
On average, CGAs identified 2.8 recommended AH or support referrals, of which patients declined 15% (48/327). Of agreed referrals, 26% (73) were for dietetics, 21% (58) for support services (chiefly social support and continence services) and 16% (45) for occupational therapy.
Interventions were most frequently recommended following timed up and go (TUG) assessment, with 72% (52/72) of patients warranting and 94% (49/52) agreeing to referral. Recommended interventions following aids (43%) and Katz activities of daily living (38%) assessments were most commonly declined.
Provisionally, the model seems feasible. Reasons for subdued uptake of recommended CGAs and referrals, and variations in completeness of CGA administration, are being analysed. Examination of potential differences in CGA rates and results following face-to-face vs. telephone screening is planned.