Improving the way we identify patients who could benefit from palliative care is essential. It addresses inequalities in access to this crucial care and ensures individuals receive the right support at the right time, aligning with their specific needs and preferences. Identifying these patients doesn’t automatically mean referring them to specialist palliative care. Instead, it should initiate a thorough and holistic assessment of their palliative care needs, as well as those of their families.
While some existing screening tools suggest actions following the screening process, a clear and effective care pathway is often lacking for individuals with advanced progressive diseases who are identified as potentially needing palliative care. Based on research, a process for patient identification and palliative care needs assessment can be visualized. The initial critical step involves using a screening tool to help pinpoint patients with advanced progressive diseases whose health is declining and who would benefit from a palliative care needs assessment. These screening tools should not solely focus on predicting mortality or deterioration. They should also proactively anticipate needs as they arise and predict the trajectory and pace of functional decline. Patients identified through screening as having potential palliative care needs can then undergo a comprehensive assessment to determine their specific 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 vital in managing the care of individuals with advanced chronic conditions. A significant challenge for these teams is identifying patients within their practice who may have unmet palliative care needs. Implementing a systematic screening tool can significantly aid primary care teams in identifying patients with advanced progressive diseases who are likely to require palliative care. However, practical challenges such as heavy workloads and limited resources in primary care settings can hinder the adoption of such screening tools. Therefore, the adoption of electronic tools is recommended to systematically and automatically identify patients who might have unmet palliative care needs, subsequently prompting the use of a comprehensive needs assessment tool. While electronic screening tools like AnticiPal and Rainoe have been utilized, their effectiveness remains questionable because they have historically relied on the risk of deterioration and mortality as indicators for palliative care needs, rather than a broader needs-based approach.
Future automated screening tools should be designed to predict functional decline and increasing care needs, in addition to mortality risk. Further research on these tools should employ robust reference standards, such as detailed palliative care interviews, to accurately evaluate whether these screening tools are effectively identifying patients with genuine palliative care needs. The integration and application of these tools within current clinical practice software can be achieved with minimal resource allocation and require minimal training, making them feasible for implementation in busy primary care practices. The widespread adoption of validated and standardized screening tools has the potential to revolutionize the identification process in primary care, leading to improved and timely access to palliative care for individuals with advanced progressive diseases and potential palliative care needs.
