Identifying Nursing Home Residents with Unmet Palliative Care Needs: A Systematic Review of Screening Tool Measurement Properties

Connie S Cole; Jessica Roydhouse; Regina M Fink; Mustafa Ozkaynak; Joan G Carpenter; Evan Plys; Shaowei Wan; Cari R Levy

doi:10.1016/j.jamda.2023.02.112

Identifying Nursing Home Residents with Unmet Palliative Care Needs: A Systematic Review of Screening Tool Measurement Properties

J Am Med Dir Assoc. 2023 May;24(5):619-628.e3. doi: 10.1016/j.jamda.2023.02.112. Epub 2023 Apr 6.

Authors

Connie S Cole¹, Jessica Roydhouse², Regina M Fink³, Mustafa Ozkaynak⁴, Joan G Carpenter⁵, Evan Plys⁶, Shaowei Wan⁷, Cari R Levy⁷

Affiliations

¹ University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: connie.cole@cuanschutz.edu.
² Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
³ University of Colorado School of Medicine, Aurora, CO, USA; University of Colorado College of Nursing, Aurora, CO, USA.
⁴ University of Colorado College of Nursing, Aurora, CO, USA.
⁵ University of Maryland School of Nursing, Baltimore, MD, USA.
⁶ Massachusetts General Hospital, Boston, MA, USA.
⁷ University of Colorado School of Medicine, Aurora, CO, USA.

PMID: 37030323
PMCID: PMC10156164 (available on 2024-05-01)
DOI: 10.1016/j.jamda.2023.02.112

Abstract

Objectives: Despite 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.

Design: Systematic review of measurement properties consistent with Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines.

Settings and participants: Embase (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.

Methods: Two reviewers independently screened, selected, extracted data, and assessed risk of bias.

Results: We 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 implications: Given 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.

Keywords: Nursing home; long-term care; palliative care; screening; systematic review.

Publication types

Systematic Review
Review
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Humans
Nursing Homes*
Palliative Care*
Reproducibility of Results
Skilled Nursing Facilities

Grants and funding

T32 AG044296/AG/NIA NIH HHS/United States