Improving the way we identify patients who could benefit from palliative care is essential. It addresses inequalities in access to care and ensures everyone receives the right support at the right time, tailored to their specific needs and preferences. This identification process isn’t about automatically referring everyone to specialist services. Instead, it’s about initiating a thorough assessment of the patient’s and their family’s palliative care needs.
Currently, even with tools designed to screen patients, there’s a lack of clear pathways to guide care for individuals with advanced progressive diseases who are identified as potentially needing palliative care. Based on research, a helpful approach is visualized in a conceptual process (Figure 2). The initial critical step involves using a Palliative Care Eligibility Screening Tool. This tool aids in identifying patients with advanced progressive illnesses whose health is declining and who would benefit from a detailed palliative care needs assessment. Effective screening tools should look beyond just predicting mortality. They should anticipate needs as they arise and forecast the pace and trajectory of functional decline. Patients flagged by these screening tools as having potential palliative care needs can then undergo comprehensive assessments to pinpoint their unmet needs. The results of these assessments are crucial for determining the necessary level of care, which might range from integrating a ‘generalist palliative care’ approach into their existing care to referring them to specialist palliative care services.
Primary care teams are central to managing patients with long-term chronic conditions. A significant challenge for these teams is recognizing which patients might be facing unmet palliative care needs. Implementing a systematic palliative care eligibility screening tool can significantly assist primary care in identifying individuals with advanced progressive diseases who are likely to require palliative support. However, practical challenges such as heavy workloads and limited resources in primary care settings can hinder the adoption of such tools. Therefore, leveraging electronic palliative care eligibility screening tools is highly recommended. These automated systems can systematically identify patients who may have unmet palliative care needs and prompt a more in-depth needs assessment. While some electronic tools like AnticiPal and Rainoe exist, their effectiveness in truly identifying palliative care needs is questionable, as they often rely on deterioration and mortality risk as primary indicators.
Future palliative care eligibility screening tool designs should prioritize predicting functional decline and increasing care needs alongside mortality predictions. To rigorously evaluate these future tools, studies should use robust reference standards, such as comprehensive palliative care interviews, to confirm whether the screening tools accurately identify patients with genuine palliative care needs. Integrating and utilizing these tools within current clinical software systems offers the advantage of requiring minimal resources, training, and capacity, making them practical for implementation even in busy primary care practices. The widespread adoption of validated and standardized palliative care eligibility screening tools has the potential to revolutionize patient identification in primary care. This transformation would significantly improve timely access to palliative care for individuals with advanced progressive diseases and unmet palliative care needs, ensuring they receive the support they require when they need it most.
