Improving the identification of patients who would benefit from palliative care is essential for addressing disparities in access to this crucial care and ensuring that individuals receive the appropriate support at the right time, tailored to their specific needs and preferences. Identifying these patients isn’t necessarily about immediate referral to specialist palliative care services. Instead, it’s about initiating a thorough and holistic evaluation of the palliative care needs of both the patient and their family.
While some identification tools suggest actions following the screening process, a well-defined care pathway for individuals with advanced progressive illnesses identified as potentially needing palliative care is often lacking. Based on research, a process for patient identification and palliative care needs assessment involves initial screening to identify individuals with deteriorating health from advanced progressive diseases who could benefit from a palliative approach. Effective screening tools should consider not only mortality and decline but also anticipate needs as they arise and predict the trajectory of functional decline. Patients flagged as potentially needing palliative care should then undergo a comprehensive assessment to pinpoint their unmet needs. The assessment outcomes can guide the level of care required, potentially leading to the integration of a general palliative care approach or referral to specialized palliative services.
Primary care teams are central to the care of individuals with advanced chronic conditions. A significant challenge for these teams is pinpointing patients with unmet palliative care needs. Implementing a systematic identification tool can aid primary care in recognizing patients with advanced progressive diseases who may require palliative care. However, practical challenges in primary care, such as heavy workloads and limited resources, can hinder the adoption of such tools. Therefore, utilizing electronic tools for automated and systematic identification of patients with potential unmet palliative care needs is recommended. This can then trigger a more in-depth needs assessment. While electronic screening tools like AnticiPal and Rainoe exist, their effectiveness is questionable because they have historically relied on the risk of deterioration and mortality as indicators for palliative care needs.
Future automated tools should be designed to predict functional decline and increasing care needs in addition to mortality risks. Further research on these tools should employ robust reference standards, such as palliative care interviews, to accurately determine if screening tools are effectively identifying patients who genuinely require palliative care. Integrating and utilizing these tools within existing clinical practice software is advantageous as it demands minimal resources, training, and capacity, making them suitable for busy primary care environments. The implementation of validated and standardized screening tools has the potential to transform the identification process in primary care, ultimately improving timely access to palliative care for individuals with advanced progressive diseases and associated palliative care needs.
