A Clustered Randomized Controlled Trial of Symptom Screening and Automatic Referral for Supportive Care for Patients with GI Cancer Care Needs

Philippa Helen Hawley, Narsis Afghari, Catherine Courteau



To explore the implementation of symptom screening and supportive/palliative care referral pathway in patients newly referred to a medical oncology clinic.


Eighty-eight subjects were recruited in each study arm. Intervention subjects were assessed by a member of the supportive/palliative care team if they had a severity score of >3/10. Controls received normal care, including discretionary referral. Symptom severity and quality of life were assessed over 5 months. Data on survival, care setting of death (home, hospice or hospital) and long-term resource use was collected for a further 2 years.


Screening led to 141 specialist supportive/palliative care visits in the intervention arm versus 9 in controls. There were no differences in symptom severity or the long-term outcomes measured. The service was however not overwhelmed.  Considerations on timing and mode of administration of screening tools were revealed.


Triaging of positive screens is an important role for oncology nurses.

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