Triage systems in palliative care - a scoping review

Background: Referrals for Palliative Care (PC) are growing in number and diversity, as PC are being integrated earlier into oncological and nononcological disease care. The process of managing a waiting list in PC is a complex decision-making process that is currently carried out without a systematic approach and is therefore susceptible to decision fatigue. Therefore, resource allocation and prioritization (triage) should be based on a systematized approach, in order to guarantee quality and equity in their provision. Aim/Research question or hypothesis: To map the knowledge available in the literature on triage systems that allow prioritization in the assessment of adults by PC teams in different settings. Methods: A systematic scoping review performed in accordance with the JBI methodology. The search was conducted using publications in international databases. Studies that described triage systems in adult PC and different contexts (hospital, community, PC unit/hospice or other health services) were included. Only articles in Portuguese, English and Spanish were considered, without any time limit. Results: From a total of 5642 publications, 122 were eligible for review based on titles and abstracts. A full text review of these publications led to the selection of 27 of these articles. From the data collected, there were identified 23 systems/strategies to triage/prioritize PC patients and allocate resources. Of these models, it is noteworthy that 5 were used in patients with oncological pathology, 2 in non-oncological disease, and 16 in both situations. The different systems present advantages, disadvantages, and their own characteristics. Discussion: The systems/methodologies described in this review can contribute to an adequate triage and prioritization of cases in the area of PC, allowing for a fair and adequate allocation of resources to meet the needs of each individual. Our results highlight the importance of using concrete methodologies/systems, based on a multidisciplinary assessment, in order to guarantee timely access to all patients who need them.