title: Implementation and evaluation of a rapid access palliative clinic in a New Zealand cancer centre.
abstract: BACKGROUND
  Palliative patients with metastatic bone pain endure long waiting times and multiple visits to radiation therapy departments for treatment. This can prolong suffering and may be a factor in patients consenting for treatment. Rapid Access Palliative Clinics (RAPC) have been established around the world to provide a multidisciplinary approach to consultation, simulation and treatment on the same day. This paper describes the implementation and evaluation of a RAPC at Waikato Regional Cancer Centre (WRCC) by reducing the time from referral to first specialist appointment (FSA).
  
  
  METHODS
  The structure and process for the RAPC day was outlined and the roles of staff were defined. A retrospective study was undertaken of the 261 consecutive patients seen in the RAPC from April 2009 to April 2013. Tracking sheets were created to record patient information at the initial consultation. Follow-up telephone calls were used to assess the patient post-treatment. Patient information was entered into a database.
  
  
  RESULTS
  A total of 226 patients received radiation therapy treatment to 307 sites. All patients were seen within 1 week of referral. Sixty-three per cent of patients were simulated and treated on the same day. The change in radiation therapy fractionation prescriptions was statistically significant (P= 0.0012). There was a statistically significant difference between initial and follow-up pain scores (P< 0.0001).
  
  
  CONCLUSIONS
  Evaluation of the clinic has shown that it compares favourably with similar international clinics. The RAPC has decreased the referral to FSA for palliative radiation therapy and reduced the number of visits the patient has to endure due to an increase in single fraction prescriptions. This has resulted in rapid reduction in pain for the majority of patients.
authors.affiliation: Waikato Regional Cancer Centre, Lomus Building, Waikato Hospital Hamilton, New Zealand.
authors.forename: Charlene
authors.initials: C
authors.lastname: Casson
authors.affiliation: Waikato Regional Cancer Centre, Lomus Building, Waikato Hospital Hamilton, New Zealand.
authors.forename: Janet
authors.initials: J
authors.lastname: Johnson
keywords: Palliative; radiation therapy; rapid access