Validation Palliative Care Screening Tool

Topic: Building Palliative Care Into the Organizational DNA

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Early identification of patients appropriate for palliative care continues to be a challenge for health care systems. We imbedded a palliative care screening tool (PCST) into our hospital’s electronic medical record (EMR) to be completed by nurses during the admission assessment. We adopted the screening tool used by the Palliative Care Center of the Bluegrass in Lexington, Kentucky (Glare and Chow, 2015 and Trout, Kirsh, and Peppin, 2012). With this tool providers are able to assess a patient’s appropriateness for a palliative care consult by considering specific criteria including advanced illness, multi-morbidity, functional status and other surrogate markers of serious illness. We elected to implement an automatic palliative care referral for patients who scored equal to or greater than eight. Although the screening tool was helpful in early identification of patients, we did not realize its full potential because: feedback from providers indicated lack of clarity in determining “advanced illness”; the tool had only been validated in the oncology population; multiple tools were used to assess functional status. Hence we proposed to revise the existing screening tool. We aim to study the following:

1. Would clarification of the definition of various advanced illnesses lead to an increase palliative care referrals?

2. Does functional status assessment impact the understanding of advanced illness?

3. Is the palliative care screening tool statistically valid when compared to another reliable method for determining prognosis, the Karnofsky performance scale?

The purpose of the research study is to validate the palliative care screening tool to a broader patient population and determine the content validity ratio.

Methods:

Approved by the BRANY Institutional Review Board, we created and distributed an online survey among 120 content experts within our institution to collect feedback on 5 categories of basic disease processes as major criterion for determination for a palliative care screening tool score.

Results:

Our findings indicate that the functional assessments, ECOG and Karnofsky are significantly associated based on the Pearson’s Chi-square test with Monte Carlo Simulation (p-value 9.999*10^-05). Furthermore, The Karnofsky scale score is significantly negatively correlated with the palliative care screening tool score (Pearson’s correlation coefficient = -.660, p-value 4.314*10^-45). The content validity ratios indicate that all providers who participated in the survey (n=120), identified poor or limited functional status as essential items upon identifying high-risk patients appropriate for palliative services. All advanced illnesses concurrent with complete ADL dependence yielded the highest positive values.

Conclusion:

The screening tool is applicable with patients with all serious illness. Assessment of functional status is an important factor in determining prognosis in serious illness. We recommend that Hospital and Community palliative care programs should consider embedding palliative care screening tools that include functional status assessments.

Author

  • Karen Mulvihill, DNP
  • Network Director Palliative Care
  • Western Connecticut Health Network
  • 24 Hospital Avenue
  • Danbury, CT 06810
  • 203-885-6267

Co-authors

  • Catherine Hall, LCSW
  • Melissa Waller, RN
  • Niki Koesel, ANP, ACHPN, FPCN

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