Identification of hospital patients in need of palliative care – a predictive score

Abstract

BackgroundPalliative care was initially developed for patients with advanced cancer. Over the past years, however, palliative care has broadened its focus from terminal cancer patients to patients with other serious, life-limiting illnesses. Nevertheless, the identification of palliative care needs (PCNs) among hospital patients remains an insufficiently investigated topic of research. The aim of our study was to describe the characteristics of hospital patients with palliative care needs and to develop a score for their identification.MethodsWe conducted an epidemiological study. Data were collected prospectively from inpatients at the University Medical Center Freiburg, Germany. For each patient discharged from a hospital ward, the treating physician had to report whether the patient had PCNs or not. The response rate was 96 %, and data from 39,849 patients could be analyzed. A binary logistic regression analysis was performed in order to identify risk factors for developing PCNs and to develop a predictive score for the identification of patients with PCNs upon their admission to the hospital. In order to validate the risk prediction model, we used a bootstrap analysis.ResultsDuring the study period, 6.9 % (2757) of all patients had palliative care needs. Only 56 of them (2 %) received palliative treatment. Binary logistic regression analysis showed that older patients without relatives who suffered from metastatic cancer and/or liver cirrhosis had the highest risk of developing palliative care needs (PCN-score; sensitivity: 0.815; specificity: 0.640).ConclusionsGiven the aging population and associated increase in the number of patients requiring palliative care, it is crucial to detect palliative care needs in hospital patients with both cancerous and non-cancerous life-limiting diseases. Our predictive score contributes to the identification of palliative care needs in patients with life-limiting diseases, which allows physicians to take the appropriate therapeutic steps.

Palliative care needs in hospitalized cancer patients: a 5-year follow-up study

“…This figure is comparable with those of other studies, even though there are differences between studies due to methodological differences [12,17,20,23]. In a study in a New Zealand Hospital, 9.2% of cancer patients were assessed to have a palliative care need [23], whereas the corresponding figure in general hospitals in Belgium was 4.8% [12].…”

“…Studies have mainly focused on the extent of symptoms and palliative care needs of cancer patients in hospices and palliative care units/programs [13][14][15][16], but some have focused on cancer patients in hospital settings [17][18][19][20]. Nonetheless, we still need more knowledge regarding the extent of palliative care needs and the prevalence and characteristics of symptoms in acute care settings in regions with limited availability of specialized palliative care.…”

IDentification of patients in need of general and specialised PALLiative care (ID-PALL©): item generation and content validity of a new interprofessional screening instrument.

“…Prevalence of patients in need of PC varies from 9% to 73% in various acute care settings, with the highest prevalence occurring in clinical settings, such as internal medicine or oncology (5)(6)(7)(8)(9)(10)(11).…”

IDentification of patients in need of general and specialised PALLiative care (ID-PALL©): item generation, content and face validity of a new interprofessional screening instrument.

“…Proportions of patients with PC needs varies (9%-73%), and people are often identified late, which bears important consequences for care (9)(10)(11)(12)(13)(14)(15)(16)(17)(18). These consequences include, but are not limited to (i) excess hospital mortality, whereby 80% of palliative patients die in hospital when the majority of people wish to die at home (19,20); (ii) suboptimal symptom management (21)(22)(23); (iii) unplanned hospitalisations with long hospital stays (24,25); (iv) prescription of inappropriate treatments due to a lack of advance care planning (26,27); and, (v) insufficient support for the patient and their relatives (24,28,29).…”