Improving the way we identify patients who could benefit from palliative care is essential. It addresses inequalities in healthcare access and ensures individuals receive timely and appropriate support tailored to their specific needs and preferences. Identifying these patients doesn’t automatically mean they need specialist palliative care, but it should initiate a thorough evaluation of their palliative care needs, as well as those of their families.
While some screening tools suggest actions following patient identification, a clear care pathway for individuals with advanced progressive illnesses who are flagged as potentially needing palliative care is still lacking. Based on research, a process for patient identification and palliative care needs assessment can be visualized (Figure 2). The initial step involves using a screening tool for palliative care to help pinpoint patients with advanced progressive conditions whose health is declining and who would benefit from a palliative care needs assessment. These tools should not only predict mortality and deterioration but also anticipate needs as they arise and forecast the pace and trajectory of functional decline. Patients identified through screening tools as having potential palliative care needs should then undergo a comprehensive assessment to determine their unmet needs. The results of this assessment can guide decisions about the necessary level of care, potentially leading to the integration of a general palliative care approach or referral to specialized palliative care services.
Primary care teams are critical in managing patients with chronic advanced diseases. A major challenge for these teams is recognizing which patients may have unmet palliative care needs. Implementing systematic Screening Tools For Palliative Care can assist primary care teams in identifying individuals with advanced progressive illnesses and potential palliative care needs. However, factors like heavy workloads and limited resources in primary care can hinder the adoption of such tools. Therefore, it’s recommended to utilize electronic screening tools that can automatically and systematically identify patients who might have unmet palliative care needs and trigger the use of a needs assessment tool. Although some electronic screening tools, like AnticiPal and Rainoe, have been used, their effectiveness is questionable because they rely on the risk of deterioration and death as indicators for palliative care needs.
Future automated screening tools for palliative care should be designed to predict functional decline and increasing needs, in addition to mortality. Future evaluations of these tools should use robust reference standards, such as palliative care interviews, to verify whether the screening tools accurately identify patients with potential palliative care needs. Integrating and utilizing these tools within existing clinical practice software requires minimal resources, training, and capacity, making them feasible for busy primary care practices. Adopting validated and standardized screening tools for palliative care would transform the identification process in primary care and improve timely access to palliative care for individuals with advanced progressive diseases and potential palliative care needs.
