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, allowing for a comprehensive assessment of the patient's needs 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.
Some key features of the NAT: PD-HF include:
- Assessment of the patient's wellbeing, including symptoms such as BREATHLESSNESS, FATIGUE, and NAUSEA AND VOMITING 1
- Evaluation of the caregiver's ability to provide care and their own wellbeing
- Identification of issues that may require referral to specialist services, such as the lack of a caregiver
- A series of prompts to assess the level of concern about unmet needs and identify the action taken by the clinician
While other tools, such as the Supportive and PC Indicators Tool (SPICT), can also help identify people who may have palliative care needs, the NAT: PD-HF is specifically designed for people with heart failure and has been validated for this population 1. Therefore, the NAT: PD-HF is the recommended tool for identifying palliative care needs in primary care, particularly for patients with heart failure.
From the Research
Palliative Care Identification Tools
The following are some of the palliative care identification tools used in primary care:
- The Surprise Question (SQ): a tool that asks the question "Would I be surprised if this patient died in the next 12 months?" 2, 3, 4, 5
- The Supportive and Palliative Care Indicators Tool (SPICT): a tool that helps identify patients who may benefit from palliative care 3
- The NECPAL CCOMS-ICO© tool: a tool that combines the Surprise Question with additional clinical parameters for a more comprehensive assessment 5
Performance Characteristics of Palliative Care Identification Tools
The performance characteristics of these tools vary:
- The Surprise Question has a sensitivity of 67.0% and specificity of 80.2% in predicting death at 6 to 18 months 2
- The SPICT has a sensitivity of 57% and specificity of 98% in predicting 1-year mortality 3
- The NECPAL CCOMS-ICO© tool has a sensitivity of 91.4% and specificity of 55.2% in predicting 24-month mortality 5
Comparison of Palliative Care Identification Tools
Studies have compared the performance of these tools:
- The SPICT seems to be better in identifying patients in need of palliative care than the Surprise Question 3
- The NECPAL CCOMS-ICO© tool has slightly better predictive validity than the Surprise Question 5
Patient Views and Experiences
There is a need to understand patient views and experiences of palliative care identification tools:
- A qualitative interview study protocol aims to provide new understanding into patient perspectives of the experience of having their palliative care needs identified 6