Use of dependency and prioritization tools by clinical nurse specialists in palliative care: an exploratory study

Aims: The principal aim was to assess the utility of three needs assessment/dependency tools for use in community-based palliative care services. Specific objectives were to assess a sample of patients receiving specialist palliative care community nursing using these tools, to assess the predictive ability of each tool, and to explore the utility of prioritizing and measuring patient dependency from a clinical nurse specialist (CNS) perspective. Method: In phase 1, 22 community-based CNSs completed the Vale prioritization tool for all patients visited during a 3-month period (n= 162). They also completed either the Graves and Payne (2007) or the Birch et al (1997) dependency tool after each visit. In phase 2 a focus group (n= 8) and two one-to-one interviews with CNS participants explored the perceived utility of all three tools. Results: The Vale prioritization tool appeared to be the most useful for prioritizing patient need and managing workload. Statistical analysis highlighted minimal differences between the two dependency tools, neither of which predicted length of visit. Three themes were identified from phase 2: difficulties with routine administration, points of divergence between the two dependency tools, and workload concerns. Conclusion: While the Vale prioritization tool emerged as the most useful, the findings raise questions about the overall utility and practical application of these kinds of tools with community-based palliative care patients. Further research is needed to identify/develop, adapt, and evaluate appropriate, setting-specific dependency tools for use with this population.