Background: The importance of early palliative care integration is increasingly recognized, yet many patients who could benefit do not receive it promptly. Implementing systematic approaches within primary care settings is crucial for the early detection of individuals who may require palliative care, facilitating timely and appropriate interventions.
Aim: This review aims to identify and evaluate the accuracy of existing screening tools designed for primary healthcare settings to detect patients with advanced progressive diseases who are likely to have palliative care needs.
Design: This study employed a rigorous systematic review methodology (registered with PROSPERO: CRD42019111568).
Data sources: A comprehensive search was conducted across major databases including Cochrane, MEDLINE, Embase, and CINAHL, covering the period from their inception up to March 2019.
Results: The systematic screening of 4,127 unique articles led to the identification of 25 articles that detailed the application or development of 10 distinct screening tools. A predominant feature of these tools is their reliance on predicting mortality and/or patient deterioration as indicators for identifying individuals with potential palliative care needs. These tools utilize a diverse set of indicators, encompassing both general health markers and disease-specific factors. Among these, the accuracy of five tools was evaluated across eight studies. The findings revealed considerable variability in their performance, with sensitivity ranging from 3% to 94% and specificity ranging from 26% to 99% in identifying patients with potential palliative care needs.
Conclusion: Current Palliative Care Screening Tools demonstrate limited capability in accurately identifying patients with advanced progressive diseases who are likely to require palliative care within primary care settings. Future research should prioritize the development of standardized screening processes. These processes should extend beyond mortality and deterioration predictions to incorporate the anticipation of palliative care needs and the prediction of the trajectory and pace of functional decline. Such advancements would facilitate comprehensive assessments, ensuring that patient needs are identified and addressed in a timely manner, thereby improving the delivery of palliative care.
