Identifying Nursing Home Residents with Unmet Palliative Care Needs: A Systematic Review of Screening Tool Measurement Properties

Cole, Connie; Roydhouse, Jessica; Fink, Regina; Ozkaynak, Mustafa; Carpenter, Joan; Plys, Evan; Wan, Shaowei; Levy, Cari

doi:10.1016/j.jamda.2023.02.112

Cited by 5 publications

(2 citation statements)

References 75 publications

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“…Notably, the quality of evidence about NECPAL was rated as low, which is consistent with findings of previous reviews. 20 22 The quality of evidence regarding the content validity of SPICT was rated as 'moderate' in this review, but was rated as very low by Teike's review. 20 One possible reason for this discrepancy is that we included the validation studies of all versions of SPICT, but Teike's review only included the development study of the original version of SPICT.…”

Section: Discussionmentioning

confidence: 89%

“…They did not conduct a meta-analysis to pool the clinical performance of the instruments. [19][20][21][22][23] Additionally, existing reviews only included instruments used within a single type of setting, such as primary care settings or hospital settings. 19-21 23 Therefore, it is unclear how screening instruments were used across different settings, and whether variations exist in their clinical performance across these instruments and different settings.…”

Section: Introductionmentioning

confidence: 99%

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Screening instruments for early identification of unmet palliative care needs: a systematic review and meta-analysis

Xie,

Ding,

Jiao

et al. 2023

BMJ Support Palliat Care

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BackgroundThe early detection of individuals who require palliative care is essential for the timely initiation of palliative care services. This systematic review and meta-analysis aimed to (1) Identify the screening instruments used by health professionals to promote early identification of patients who may benefit from palliative care; and (2) Assess the psychometric properties and clinical performance of the instruments.MethodsA comprehensive literature search was conducted in PubMed, Embase, CINAHL, Scopus, CNKI and Wanfang from inception to May 2023. We used the COnsensus-based Standards for the Selection of Health Measurement INstruments to assess the methodological quality of the development process for the instruments. The clinical performance of the instruments was assessed by narrative summary or meta-analysis. Subgroup analyses were conducted where necessary. The quality of included studies was assessed using the Newcastle-Ottawa Scale and the Cochrane Collaboration’s risk of bias assessment tool.ResultsWe included 31 studies that involved seven instruments. Thirteen studies reported the development and validation process of these instruments and 18 studies related to assessment of clinical performance of these instruments. The content validity of the instruments was doubtful or inadequate because of very low to moderate quality evidence. The pooled sensitivity (Se) ranged from 60.0% to 73.8%, with high heterogeneity (I2 of 88.15% to 99.36%). The pooled specificity (Sp) ranges from 70.4% to 90.2%, with high heterogeneity (I2 of 96.81% to 99.94%). The Supportive and Palliative Care Indicators Tool (SPICT) had better performance in hospitals than in general practice settings (Se=79.8% vs 45.3%, p=0.004; Sp=59.1% vs 97.0%, p=0.000).ConclusionThe clinical performance of existing instruments in identifying patients with palliative care needs early ranged from poor to reasonable. The SPICT is used most commonly, has better clinical performance than other instruments but performs better in hospital settings than in general practice settings.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Screening instruments for early identification of unmet palliative care needs: a systematic review and meta-analysis

Xie,

Ding,

Jiao

et al. 2023

BMJ Support Palliat Care

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“We're Onto Something Here!”: Clinician Perspectives of a Pilot Program to Increase Palliative Care Access in an Urban Skilled Nursing Facility

Calton,

Williams,

Jaramillo

et al. 2024

Journal of the American Medical Directors Association

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A Nurse Practitioner–Driven Palliative and Supportive Care Service in Nursing Homes

Carpenter,

Murthi,

Langford

et al. 2024

J Hosp Palliat Nurs

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This article describes a quality improvement project implemented by a national postacute long-term care organization aimed at enhancing the provision of palliative care to nursing home residents. The project focused on improving advance care planning, end-of-life care, symptom management, and care of people living with serious illness. Both generalist and specialist palliative care training were provided to nurse practitioners in addition to implementing a system to identify residents most likely to benefit from a palliative approach to care. To evaluate the nurse practitioner experiences of the program, survey data were collected from nurse practitioners (N = 7) involved in the project at 5 months after implementation. Nurse practitioners reported the program was well received by nursing home staff, families, and residents. Most nurse practitioners felt more confident managing residents' symptoms and complex care needs; however, some reported needing additional resources for palliative care delivery. Most common symptoms that were managed included pain, delirium, and dyspnea; most common diagnoses cared for were dementia and chronic organ failure (eg, cardiac, lung, renal, and neurological diseases). In the next steps, the project will be expanded throughout the organization, and person- and family-centered outcomes will be evaluated.

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Identifying Nursing Home Residents with Unmet Palliative Care Needs: A Systematic Review of Screening Tool Measurement Properties

Cited by 5 publications

References 75 publications

Screening instruments for early identification of unmet palliative care needs: a systematic review and meta-analysis

Screening instruments for early identification of unmet palliative care needs: a systematic review and meta-analysis

“We're Onto Something Here!”: Clinician Perspectives of a Pilot Program to Increase Palliative Care Access in an Urban Skilled Nursing Facility

A Nurse Practitioner–Driven Palliative and Supportive Care Service in Nursing Homes

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