From the Guidelines
The most effective palliative care identification tools in primary care are the Supportive and Palliative Care Indicators Tool (SPICT), which can be used to guide referral, as mentioned in the study by 1. These tools are essential for identifying patients who could benefit from palliative care support, allowing for earlier intervention and better quality of life. The SPICT provides clear clinical indicators across multiple conditions, making it a valuable resource for clinicians. In addition to SPICT, other tools like the Gold Standards Framework Proactive Identification Guidance (GSF PIG) and the Surprise Question can also be useful in identifying patients who may benefit from palliative care. However, the study by 1 highlights the importance of collaborations between specialist palliative teams and non-PC providers, and the use of tools like SPICT to guide referral. Some key points to consider when using these tools include:
- Integrating them into routine primary care processes
- Using them during routine care reviews, annual assessments for patients with chronic conditions, or when there are significant changes in health status
- Focusing on identifying the transition to a palliative care approach based on needs rather than prognosis alone
- Considering the use of multiple tools, such as SPICT, GSF PIG, and the Surprise Question, to prompt further assessment and guide referral. The study by 1 also mentions the use of patient-reported symptoms and other indicators, such as persistent severe impairment of quality of life and escalating symptoms, to identify the need for a palliative approach, but the most recent and highest quality study 1 prioritizes the use of SPICT.
From the Research
Palliative Care Identification Tools
The following are some of the palliative care identification tools used in primary care:
- The Surprise Question ("Would I be surprised if this patient were to die within the next 12 months?") 2
- The Double Surprise Question, which combines the original Surprise Question with an additional question ("Would I be surprised if this patient is still alive after 12 months?") 2
- The Supportive and Palliative Care Indicators Tool (SPICT) 3, 4
- Other tools identified in the literature, including the Gold Standards Framework 3 and the Radboud Indicators for Palliative Care 3
Characteristics of Palliative Care Identification Tools
The characteristics of these tools vary, with some using prediction of death and/or deterioration as a proxy for the identification of people with potential palliative care needs 5. The tools are based on a wide range of general and disease-specific indicators 5. The accuracy of these tools also varies, with sensitivity ranging from 3% to 94% and specificity ranging from 26% to 99% 5.
Use of Palliative Care Identification Tools in Primary Care
The use of these tools in primary care is not widespread, with many general practitioners (GPs) relying on their own clinical judgement and information received from the hospital to identify patients with palliative care needs 3. However, the use of tools such as the SPICT has been shown to be effective in identifying patients with palliative care needs in hospital settings 4.
Limitations of Palliative Care Identification Tools
The limitations of these tools include their variable accuracy and the lack of standardization in their use 5, 4. Further research is needed to identify standardized 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 5.