• Bethany Russell, Sara Vogrin, Jennifer Philip, Nicole Hennessy-Anderson, Anna Collins, Jodie Burchell, Brian Le, Caroline Brand, Peter Hudson, and Vijaya Sundararajan.
• Palliative Medicine Research Group, University of Melbourne & St Vincent's Hospital Melbourne, Melbourne, Australia; Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Australia. Electronic address: beth.russell@svha.org.au.
• J Pain Symptom Manage. 2020 Jan 1; 59 (1): 95-104.e11.

ContextEvidence-based resource allocation is receiving increasing attention as we strive for equity, transparency, and cost-effectiveness across health care. In the context of finite resources, which of our patients with terminal illness should be prioritized for urgent palliative care?ObjectivesTo develop the scoring system for the novel Responding to Urgency of Need in Palliative Care triage tool.MethodsOnline international discrete choice experiment involving palliative care clinicians to establish the relative importance of seven key attributes of palliative care triage identified during an earlier qualitative study.ResultsParticipants (n = 772) were mainly female (79.9%) with a decade of clinical experience. All attributes contributed significantly (all P-values < 0.001) and independently to clinician assessment of urgency. This study found physical suffering (coefficient 3.45; 95% confidence interval: 3.24 to 3.66) was the most important determinant of urgency, followed by imminent dying (coefficient 1.56; 1.43 to 1.69), psychological suffering (coefficient 1.49; 1.37 to 1.60), caregiver distress (coefficient 1.47; 1.35 to 1.59), discrepancy between care needs and care arrangements (coefficient 1.14; 1.02 to 1.26), mismatch between current and desired site of care (coefficient 0.94; 0.85 to 1.03), and unmet communication needs (coefficient 0.84; 0.76 to 0.92).ConclusionPalliative care triage, which is complex and contextual, has been made more transparent through this discrete choice experiment. The Responding to Urgency of Need in Palliative Care triage tool provides an important step toward evidence-based assessment of priority for palliative care. Further research is underway to determine the validity of the tool in clinical practice and its impact on patient and caregiver outcomes.Copyright © 2019 American Academy of Hospice and Palliative Medicine. All rights reserved.

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