Identifying Nursing Home Residents with Unmet Palliative Care Needs: A Systematic Review of Screening Tool Measurement Properties |
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| Institution: | 1. University of Colorado School of Medicine, Aurora, CO, USA;2. Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia;3. University of Colorado College of Nursing, Aurora, CO, USA;4. University of Maryland School of Nursing, Baltimore, MD, USA;5. Massachusetts General Hospital, Boston, MA, USA;1. Sunnybrook Health Sciences Centre, Toronto, ON, Canada;2. Department of Surgery, University of Toronto, Toronto, ON, Canada;3. Baycrest Apotex Centre, Toronto, ON, Canada;4. Department of Medicine, University of Toronto, Toronto, ON, Canada;5. Unity Health Toronto, Toronto, ON, Canada;6. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada;7. Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada;1. Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy;2. Healthy Aging Phenotypes Research Unit–“Salus in Apulia Study”–National Institute of Gastroenterology \"Saverio de Bellis\", Research Hospital, Castellana Grotte, Bari, Italy;3. Psychiatric Unit, Department of Clinical & Experimental Medicine, University of Foggia, Foggia, Italy;4. Neuroscience and Education, Human Resources Excellence in Research, University of Foggia, Foggia, Italy;5. Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands;6. Hematology and Stem Cell Transplant Unit, \"Vito Fazzi\" Hospital, Lecce, Italy;7. Department of Neuroscience, Catholic University of Sacred Heart, Rome, Italy;8. Neurology Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy;9. Dipartimento Interdisciplinare di Medicina, Clinica Medica e Geriatria “Cesare Frugoni”, University of Bari Aldo Moro, Bari, Italy;1. Department of Nutrition and Dietetics, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands;2. Department of Neurology, Amsterdam Neuroscience, Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands;3. Department of Nutrition and Health, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands;4. Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands;5. Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands;6. Department of Epidemiology & Biostatistics, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands;7. Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam and the Amsterdam Public Health Research Institute, Amsterdam, the Netherlands;1. Big Data Center for Clinical Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China;2. Internet Medical and System Applications of National Engineering Laboratory, Zhengzhou, Henan, P. R. China;3. Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China;4. Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China;1. Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK;2. Department of Orthopaedics, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK;3. Care Quality Improvement Department, Royal College of Physicians, London, UK;4. National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK;5. University Hospital of Wales and School of Medicine, Cardiff University, UK |
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| Abstract: | ObjectivesDespite common use of palliative care screening tools in other settings, the performance of these tools in the nursing home has not been well established; therefore, the purpose of this review is to (1) identify palliative care screening tools validated for nursing home residents and (2) critically appraise, compare, and summarize the quality of measurement properties.DesignSystematic review of measurement properties consistent with Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines.Settings and participantsEmbase (Ovid), MEDLINE (PubMed), CINAHL (EBSCO), and PsycINFO (Ovid) were searched from inception to May 2022. Studies that (1) reported the development or evaluation of a palliative care screening tool and (2) sampled older adults living in a nursing home were included.MethodsTwo reviewers independently screened, selected, extracted data, and assessed risk of bias.ResultsWe identified only 1 palliative care screening tool meeting COSMIN criteria, the NECesidades Paliativas (NEC-PAL, equivalent to palliative needs in English), but evidence for use with nursing home residents was of low quality. The NEC-PAL lacked robust testing of measurement properties such as reliability, sensitivity, and specificity in the nursing home setting. Construct validity through hypothesis testing was adequate but only reported in 1 study. Consequently, there is insufficient evidence to guide practice. Broadening the criteria further, this review reports on 3 additional palliative care screening tools identified during the search and screening process but which were excluded during full-text review for various reasons.Conclusion and ImplicationsGiven the unique care environment of nursing homes, we recommend future studies to validate available tools and develop new instruments specifically designed for nursing home use. In the meantime, we recommend that clinicians consider the evidence presented here and choose a screening instrument that best meets their needs. |
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| Keywords: | Nursing home long-term care palliative care screening systematic review |
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