NECPAL tool prognostication in advanced chronic illness: a rapid review and expert consensus

Gómez-Batiste, Xavier; Turrillas, Pamela; Tebé, Cristian; Calsina-Berna, Agnès; Amblàs-Novellas, Jordi

doi:10.1136/bmjspcare-2019-002126

Cited by 23 publications

(21 citation statements)

References 45 publications

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“…In contrast, the availability of validated screening instruments enabled the identification of ACPs based on a robust construct. In our setting, the NECPAL tool, a validated instrument for the early identification of the need for palliative care among individuals with limited life expectancy, is routinely used [ 26 , 40 , 41 ]. Despite differences in the application of the concept of palliative care among countries (i.e., patients with oncologic conditions and in the last weeks or days of life vs. management of advanced chronic conditions), the definition of ACPs included in the Catalan healthcare plan used a robust method for identification, similar to other countries, potentially enabling comparisons among different countries/settings.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Service Utilization by Complex Chronic and Advanced Chronic Patients in Catalonia: A Retrospective Seven-Year Cohort-Based Study of an Implemented Chronic Care Program

Santaeugènia

Contel

Vela

et al. 2021

IJERPH

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The Chronic Care Program introduced in Catalonia in 2011 focuses on improving the identification and management of complex chronic (CCPs) and advanced chronic patients (ACPs) by implementing an individualized care model. Its first stage is their identification based on chronicity, difficult clinical management (i.e., complexity), and, in ACPs, limited life prognosis. Subsequent stages are individual evaluation and implementation of a shared personalized care plan. This retrospective study, including all CCPs and ACPs identified in Catalonia between 2013 and 2019, was aimed at describing the characteristics and healthcare service utilization among these patients. Data were obtained from an administrative database and included sociodemographic, clinical, and service utilization variables and morbidity-associated risk according to the Adjusted Morbidity Groups (GMA) stratification. During the study period, CCPs’ and ACPs’ prevalence increased and was higher in lower-income populations; most cases were women. CCPs and ACPs had all comorbidities at higher frequencies, higher utilization of healthcare services, and were more frequently at high risk (63% and 71%, respectively) than age-, sex-, and income level-adjusted non-CCP (23%) and non-ACP populations (30%). These results show effective identification of the program’s target population and demonstrate that CCPs and ACPs have a higher burden of multimorbidity and healthcare needs

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Section: Discussionmentioning

confidence: 99%

Characteristics and Service Utilization by Complex Chronic and Advanced Chronic Patients in Catalonia: A Retrospective Seven-Year Cohort-Based Study of an Implemented Chronic Care Program

Santaeugènia

Contel

Vela

et al. 2021

IJERPH

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“…NECPAL’s predictive validity had already been tested in a Spanish cohort of a prevalence study, with high sensitivity and negative predictive value but limited specificity in predicting 24-month death [ 22 ]. Later, some NECPAL parameters have been independently associated with mortality risk in different populations [ 23 ]. In a previous study, we constructed a predictive model in one of the current Argentinian hospitals to identify individuals with PC needs for 24 months [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Palliative and prognostic approach in cancer patients identified in the multicentre NECesidades PALiativas 2 study in Argentina

Tripodoro¹,

Llanos²,

Daud³

et al. 2021

ecancer

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Background Early identification of palliative needs has proven benefits in quality of life, survival and decision-making. The NECesidades PALiativas (NECPAL) Centro Coordinador Organización Mundial de la Salud - Instituto Catalán de Oncología (CCOMS-ICO©) tool combines the physician’s insight with objective disease progression parameters and advanced chronic conditions. Some parameters have been independently associated with mortality risk in different populations. According to the concept of the ‘prognostic approach’ as a companion of the ‘palliative approach’, predictive models that identify individuals at high mortality risk are needed. Objective We aimed to identify prognostic factors of mortality in cancer in our cultural context. Method We assessed cancer patients with palliative needs until death using this validated predictive tool at three hospitals in Buenos Aires City. This multifactorial, quantitative and qualitative non-dichotomous assessment process combines subjective perception (the surprise question: Would you be surprised if this patient dies in the next year?) with other parameters, including the request (and need) for palliative care (PC), the assessment of disease severity, geriatric syndromes, psychosocial factors and comorbidities, as well as the use of healthcare resources. Results 2,104 cancer patients were identified, 681 were NECPAL+ (32.3%). During a 2-year follow-up period, 422 NECPAL+ patients died (61.9%). The mean overall survival was 8 months. A multivariate model was constructed with significant indicators in univariate analysis. The best predictors of mortality were: nutritional decline ( p < 0.000), functional decline ( p < 0.000), palliative performance scale (PPS) ≤ 50 ( p < 0.000), persistent symptoms ( p < 0.002), functional dependence ( p < 0.000), poor treatment response ( p < 0.000), primary cancer diagnosis ( p = 0.024) and condition (in/outpatients) ( p < 0.000). Only three variables remained as survival predictors: low response to treatment ( p < 0.001), PPS ≤ 50 ( p < 0.000) and condition (in/outpatients) ( p < 0.000). Conclusion This prospective model aimed to improve cancer survival prediction and timely PC referral in Argentinian hospitals.

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“…24 26-28 EOLp were identified using the NECPAL (NECesidades PALiativas, palliative care needs) tool, a validated tool for the early identification of the need for palliative care among individuals with limited life expectancy. [29][30][31] EOLp were classified into the three archetypal end-of-life trajectories according to the severity and/or progression criteria for their main underlying disease: cancer, organ failure (including chronic pulmonary disease, chronic heart disease, serious chronic liver disease and serious chronic renal disease) and dementia (including other chronic neurological diseases). People with palliative care needs without a predominant advanced disease were identified as 'multimorbidity' group or trajectory, since all had two or more underlying chronic conditions.…”

Section: Variables and Data Sourcesmentioning

confidence: 99%

Frailty degree and illness trajectories in older people towards the end-of-life: a prospective observational study

et al. 2021

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ObjectivesTo assess the degree of frailty in older people with different advanced diseases and its relationship with end-of-life illness trajectories and survival.MethodsProspective, observational study, including all patients admitted to the Acute Geriatric Unit of the University Hospital of Vic (Spain) during 12 consecutive months (2014–2015), followed for up to 2 years. Participants were identified as end-of-life people (EOLp) using the NECPAL (NECesidades PALiativas, palliative care needs) tool and were classified according to their dominant illness trajectory. The Frail-VIG index (Valoración Integral Geriátrica, Comprehensive Geriatric Assessment) was used to quantify frailty degree, to calculate the relationship between frailty and mortality (Receiver Operating Characteristic (ROC) curves), and to assess the combined effect of frailty degree and illness trajectories on survival (Cox proportional hazards model). Survival curves were plotted using the Kaplan-Meier estimator with participants classified into four groups (ie, no frailty, mild frailty, moderate frailty and advanced frailty) and were compared using the log-rank test.ResultsOf the 590 persons with a mean (SD) age of 86.4 (5.6) years recruited, 260 (44.1%) were identified as EOLp, distributed into cancer (n=31, 11.9%), organ failure (n=79, 30.4%), dementia (n=86, 33.1%) and multimorbidity (n=64, 24.6%) trajectories. All 260 EOLp had some degree of frailty, mostly advanced frailty (n=184, 70.8%), regardless of the illness trajectory, and 220 (84.6%) died within 2 years. The area under the ROC curve (95% CI) after 2 years of follow-up for EOLp was 0.87 (0.84 to 0.92) with different patterns of survival decline in the different end-of-life trajectories (p<0.0001). Cox regression analyses showed that each additional deficit of the Frail-VIG index increased the risk of death by 61.5%, 30.1%, 29.6% and 12.9% in people with dementia, organ failure, multimorbidity and cancer, respectively (p<0.01 for all the coefficients).ConclusionsAll older people towards the end-of-life in this study were frail, mostly with advanced frailty. The degree of frailty is related to survival across the different illness trajectories despite the differing survival patterns among trajectories. Frailty indexes may be useful to assess end-of-life older people, regardless of their trajectory.

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NECPAL tool prognostication in advanced chronic illness: a rapid review and expert consensus

Cited by 23 publications

References 45 publications

Characteristics and Service Utilization by Complex Chronic and Advanced Chronic Patients in Catalonia: A Retrospective Seven-Year Cohort-Based Study of an Implemented Chronic Care Program

Characteristics and Service Utilization by Complex Chronic and Advanced Chronic Patients in Catalonia: A Retrospective Seven-Year Cohort-Based Study of an Implemented Chronic Care Program

Palliative and prognostic approach in cancer patients identified in the multicentre NECesidades PALiativas 2 study in Argentina

Frailty degree and illness trajectories in older people towards the end-of-life: a prospective observational study

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