From the Guidelines
The best palliative care identification tool in primary care is the Needs Assessment Tool: Progressive Disease-HF (NAT: PD-HF), as it has been validated for people with heart failure and can help identify individuals who can benefit from palliative care. This tool is particularly useful as it includes four major sections: the patient’s wellbeing; the caregiver’s ability to provide care; the caregiver’s wellbeing; and issues that should raise consideration of referral to specialist services 1. The NAT: PD-HF can be completed in less than a minute at the end of a consultation and has been shown to reduce the level of unmet needs without prolonging consultations 1.
Key Features of NAT: PD-HF
- Includes four major sections to assess patient and caregiver needs
- Can be completed in less than a minute
- Helps identify individuals with significant concerns who may benefit from palliative care
- Has been validated for people with heart failure and translated into multiple languages
Implementation in Primary Care
The NAT: PD-HF can be integrated into routine clinical workflows, such as during annual wellness visits or chronic disease management appointments. Primary care providers can use this tool to systematically identify patients who might benefit from palliative care approaches and prompt earlier discussions about goals of care 1. Regular team meetings to discuss identified patients can help coordinate care planning and ensure that patients receive comprehensive and supportive care.
Benefits of Early Palliative Care Identification
Early identification of patients who may benefit from palliative care can improve quality of life, symptom management, and alignment of care with patient preferences 1. By using tools like the NAT: PD-HF, primary care providers can play a critical role in ensuring that patients receive timely and appropriate palliative care, which can have a significant impact on morbidity, mortality, and quality of life.
From the Research
Palliative Care Identification Tools
The following are some of the palliative care identification tools used in primary care:
- Surprise Question (SQ): a tool that asks clinicians if they would be surprised if a patient died within a certain timeframe, usually 12 months 2, 3, 4, 5, 6
- Supportive and Palliative Care Indicators Tool (SPICT): a tool that uses a combination of clinical parameters to identify patients who may benefit from palliative care 2
- NECPAL CCOMS-ICO© (NECPAL) tool: a tool that combines the Surprise Question with additional clinical parameters to identify patients with palliative care needs 3
- Double Surprise Question: a tool that uses two Surprise Questions to improve the identification of patients at risk of dying within 1 year 4
- Modified Surprise Question (MSQ): a tool that asks clinicians if they would be surprised if a patient died during their hospital stay 6
Performance Characteristics of Palliative Care Identification Tools
The performance characteristics of these tools vary:
- Surprise Question: sensitivity 50-91.4%, specificity 98-100%, positive predictive value 44.6-74%, negative predictive value 25.9-84.2% 2, 3, 4, 5
- SPICT: sensitivity 57-81%, specificity 98%, positive predictive value not reported, negative predictive value not reported 2
- NECPAL: sensitivity 87.5%, specificity not reported, positive predictive value not reported, negative predictive value 81.7% 3
- Double Surprise Question: positive predictive value 74%, negative predictive value not reported 4
- MSQ: associated with increased documentation of surrogate decision makers, goals of care conversations, palliative care consultations, and hospice consultations 6
Clinical Applications of Palliative Care Identification Tools
These tools can be used in various clinical settings: