Identification of patients with potential palliative care needs: A systematic review of screening tools in primary care

Abstract

Background: Despite increasing evidence of the benefits of early access to palliative care, many patients do not receive palliative care in a timely manner. A systematic approach in primary care can facilitate earlier identification of patients with potential palliative care needs and prompt further assessment. Aim: To identify existing screening tools for identification of patients with advanced progressive diseases who are likely to have palliative care needs in primary healthcare and evaluate their accuracy. Design: Systematic review (PROSPERO registration number CRD42019111568). Data sources: Cochrane, MEDLINE, Embase and CINAHL were searched from inception to March 2019 Results: From 4,127 unique articles screened, 25 reported the use or development of 10 screening tools. Most tools use prediction of death and/or deterioration as a proxy for the identification of people with potential palliative care needs. The tools are based on a wide range of general and disease-specific indicators. The accuracy of five tools was assessed in eight studies; these tools differed significantly in their ability to identify patients with potential palliative care needs with sensitivity ranging from 3% to 94% and specificity ranging from 26% to 99%. Conclusion: The ability of current screening tools to identify patients with advanced progressive diseases who are likely to have palliative care needs in primary care is limited. Further research is needed to identify standardised screening processes that are based not only on predicting mortality and deterioration but also on anticipating the palliative care needs and predicting the rate and course of functional decline. This would prompt a comprehensive assessment to identify and meet their needs on time.

Palliative care needs-assessment and measurement tools used in patients with heart failure: a systematic mixed-studies review with narrative synthesis

“…NAT:PD-HF was not identified in three previous systematic reviews that looked for tools used to identify general populations with palliative care needs in primary care [28,32,39]. It was probably seen as a needs identification rather than a patient identification tool.…”

“…The tools are not necessarily mutually exclusive; indeed, they can be used for different, and possibly complementary, purposes. One scenario is the use of one tool to screen for patients who require palliative care (patient identification), followed by another tool to evaluate their needs more comprehensively (needs identification) [32]. In this case, the patient identification tool provides a quick snapshot of patient needs, while the needs identification tool provides a more complete picture and holistic evaluation of these needs [27].…”

“…To be clinically relevant, palliative care needs-assessment/ measurement tools should be successfully implemented in practice by healthcare professionals. Barriers to implementation include high workload of healthcare professionals and limited resources and capacities; lack of expertise, knowledge, education, and training about palliative care in heart failure; and lack of communication skills with patients and informal caregivers [32,59]. Additional barriers adopted from similar discussions on implementing advance care planning in heart failure care, where needs-assessment is a key element [95], exist on different levels.…”

“…The intended use of the tools is another important factor to guide the selection of appropriate tools [31]. While some tools are mainly used as screening instruments to identify patients who require palliative care based on their deteriorating health and potential palliative care needs (patient identification tools), others are primarily used to provide a more holistic evaluation of those unmet needs (needs identification tools) [32]. Furthermore, while some tools are designed to measure patient needs (needs-measurement tools), others are designed to assess these needs as clinical decision aids (needsassessment tools) [33].…”

“…There are no systematic reviews to critique these tools in identifying patients with heart failure who have palliative care needs. Three systematic reviews demonstrated tools that could be used to identify palliative care patients in primary care settings [28,32,39]. However, these were not specific to heart failure populations and limited to one setting.…”