Are Palliative Care Screening Tools Beneficial in Nursing Homes?

The use of palliative care screening tools in various health care settings is well-established; however, their performance in nursing homes remains uncertain. This systematic review aims to identify and evaluate palliative care screening tools validated for nursing home residents. The review follows the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines for assessing the measurement properties of the identified tools.

The search was conducted in major databases, including Embase, MEDLINE, CINAHL, and PsycINFO. Eligible studies focused on the development or evaluation of palliative care screening tools and included older adults residing in nursing homes. Two independent reviewers screened the studies, extracted data, and assessed the risk of bias.

The results of the review revealed only one palliative care screening tool, the NECesidades Paliativas (NEC-PAL), which met the COSMIN criteria. However, the evidence supporting its use in the nursing home setting was of low quality. The NEC-PAL lacked comprehensive testing of measurement properties such as reliability, sensitivity, and specificity in nursing home residents. Additionally, only one study reported construct validity through hypothesis testing.

Consequently, there is insufficient evidence to guide clinical practice. Furthermore, the review identified three additional palliative care screening tools during the search process. However, these tools were excluded during the full-text review due to various reasons.

In conclusion, the performance and validation of palliative care screening tools for nursing home residents are currently limited. Given the unique care environment of nursing homes, it is crucial to conduct further studies to validate existing tools and develop new instruments specifically tailored for nursing home use. Clinicians should consider the evidence presented in this review and select a screening instrument that best suits their needs. Improving the availability and quality of palliative care screening tools in nursing homes will contribute to the delivery of appropriate and timely palliative care interventions, ultimately enhancing the quality of life for residents with serious illnesses.

Further research and development in this area are warranted to address the current gap in knowledge and improve palliative care in the nursing home setting.

Reference:

Cole CS, Roydhouse J, Fink RM, et al. Identifying Nursing Home Residents with Unmet Palliative Care Needs: A Systematic Review of Screening Tool Measurement Properties. J Am Med Dir Assoc. 2023;24(5):619-628.e3. doi:10.1016/j.jamda.2023.02.112