Efectividad de herramientas para la identificación precoz de necesidades paliativas en la atención primaria: revisión sistemática

Early identification of palliative care needs in primary care represents a critical clinical challenge in the face of an aging population and the progressive rise of advanced chronic diseases. A systematic qualitative review was conducted following PRISMA standards to evaluate the clinical utility, feasibility, and diagnostic accuracy of the SPICT and NECPAL tools. Findings demonstrate that systematic use of the SPICT tool optimizes diagnostic sensitivity, achieving up to 57% accuracy, compared to 50% with the traditional "surprise question" and increasing effectiveness to 81% when excluding unforeseen sudden events; furthermore, its utility improves markedly when integrated into electronic health records. Meanwhile, the NECPAL model complements this screening by linking general indicators of functional decline and advanced frailty with the needs of the family support system and a systematic analysis of cross-cutting geriatric syndromes. A review of the literature shows that the structured use of these tools significantly reduces futile emergency hospital admissions, optimizes the appropriateness of therapeutic interventions by curbing inappropriate polypharmacy, and substantially alleviates informal caregiver burden across the various clinical trajectories analyzed. It is concluded that both SPICT and NECPAL are highly effective instruments for the timely initiation of community-integrated, generalist palliative care plans.