Identifying the need for specialized palliative care in adult cancer patients – development and validation of a screening procedure based on proxy assessment by physicians and filter questions

Abstract

Background One challenge in caring for cancer patients with incurable disease is the adequate identification of those in need for specialized palliative care (SPC). The study’s aim was to validate an easy to use phenomenological screening tool. Methods The German tool is based on the National Comprehensive Cancer Network (NCCN) Palliative Care guidelines and contains ten items in five domains that focus e.g. on diagnosis, functional status, complications, comorbidities, and palliative care relevant problems such as symptom management, distress, and support of family and team members. Sum score ranges from 0 to 14 (no need to great need). Assessment to identify SPC needs was done in university hospital wards between 1 and 08/2017 by health care professionals on admission of the patient if the disease was incurable and expected prognosis < 12 months. The Integrated Palliative Outcome Scale (IPOS, staff version), an outcome assessment instrument for palliative care that consists of ten items, served as external criterion; in sub samples inter-rater/test-retest were performed. Results Data from 208 patients with incurable disease and life expectancy < 12 months (54.8% female; average age 63.5 years, range 21–96) were assessed using the tool. The tool has good convergent validity; the correlation between the sum scores of IPOS and our tool showed a significant and substantial effect. The sum score was independent of the patient’s age, gender and primary diagnosis. Patients who already were in contact with SPC had significantly higher screening scores than patients without. With a cut point of ≥ 5, 80.8% of the screened patients were in need for SPC. Cronbach’s alpha was α = .600. Rater agreement (inter-rater, test-retest) varied between single items. Correlation coefficients showed significant substantial effects. Conclusions This is the first validation of a screening procedure in German language identifying SPC needs of adult patients with advanced cancer and the first using filter questions as a pre-screening. Proxy assessment of SPC needs by physicians in cancer care settings is feasible and the suggested tool presents a valid instrument to trigger a PC consultation. Trial registration The study was not registered.

Severe symptoms and very low quality-of-life among outpatients newly diagnosed with advanced cancer: data from a multicenter cohort study

“…The importance of screening and identification of unmet symptoms and needs and the subsequent integration of specialist palliative care have been emphasized and may result in better patient-relevant outcomes [31]. The large percentage of severely affected advanced cancer patients with a recent advanced cancer diagnosis yielded in this study adds to the discussion of how burdened patients should be identified [32][33][34]. In a Delphi study with nearly 60 international experts, 11 criteria concerning a possible outpatient palliative care referral were found in a consensus process [34].…”

Screening Patients With Cancer Admitted to Hanoi Medical University Hospital for Palliative Care Needs

“…This percentage was lower than previous evaluations of the tool in the United States and Germany. 11 , 12 In the United States, the tool was developed and tested in patients hospitalized under the GI Oncology Service—also the most common tumor primary site in our survey—at a large US comprehensive cancer center (CCC). The GI Oncology Service was selected because they were perceived to have a high level of unmet PC need.…”

“…Five was chosen as the cut point on the basis of previous testing of the tool. 11 , 12 In these studies, a score of ≥ 5 was highly predictive for meeting one or more of the National Comprehensive Cancer Network’s (NCCN) criteria for specialist PC referral. 6 To determine the usefulness of the screening process, we sought to determine its yield, which we defined as the number of patients who screened positive who were not already referred to the specialist PC service.…”

“…We used an 11-item, PC screening tool ( Fig 1 ), which has been shown to be valid and feasible to use in routine inpatient oncology practice in the United States and when translated into German. 11 , 12 We translated the tool into Vietnamese for convenience (Data Supplement).…”

“…The aim of this study was to evaluate the feasibility and clinical usefulness of the Vietnamese translation of a validated PC screening tool, 10 , 11 so that we may improve selection of patients for referral to our limited specialist PC resources. We hypothesized that the Vietnamese translation of the tool would be easy to incorporate into routine patient care and would be clinically useful to busy oncology house staff to systematically identify which patients would obtain the greatest benefit from specialist PC referral.…”