Enhancing identification of potential palliative care needs in older adults: An umbrella review of screening instruments

Background: Identifying palliative care needs in older adults is challenging due to variations in the indicator focus, applicability, and sensitivity of existing instruments. Aim: To systematically review the appropriate instruments for identifying potential palliative care needs in older adults and to assess their clinical performance and effectiveness. Design: We conducted an umbrella review of systematic reviews that evaluated validated instruments for identifying palliative care needs in older adults across any healthcare setting (PROSPERO registration number: CRD42024616393). Data sources: PubMed, Web of Science, CINAHL, Cochrane Library, CNKI, WangFang, and VIP databases were used to systematically search for published studies from their inception to October 2024. Results: Eleven systematic reviews were included in this study and a total of 29 instruments were identified in the literature. Of these, eight provided data on clinical performance. The Surprise Question (SQ), Supportive and Palliative Care Indicators Tool (SPICT), Necesidades Paliativas (Palliative Needs) (NECPAL), and the Palliative Care Rapid Emergency Screening (P-CaRES) were the most frequently identified instruments in older adults. Findings regarding the prognostic capacity of these instruments were inconsistent across the reviews. While three reviews reported the effectiveness of these instruments, evidence on their impact remains limited. Conclusion: The SPICT and NECPAL instruments have been implemented across diverse healthcare settings, including inpatient, outpatient, and general practice environments, demonstrating good sensitivity in their applications, while the P-CaRES is recommended for identifying palliative care needs in emergency departments. Future research should employ rigorous study designs to validate their effectiveness in enhancing patient-centered outcomes.