188 Identification of patients with potential palliative care needs: a systematic review of screening tools in primary care

Background Despite increasing evidence of the benefits of early access to palliative care (PC), many patients do not receive PC in a timely manner. A systematic approach in primary care can facilitate early identification of patients with potential PC needs and prompt assessment of their needs. Aim To identify existing screening tools for identification of patients with advanced diseases who are likely to have PC needs in primary health care and evaluate their accuracy. Methods The protocol was registered with Prospero, registration number CRD42019111568. Searches of MEDLINE, Embase, Cochrane and CINAHL, from inception to March 2019. Studies mentioning the use or development of a screening tool to identify patients with advanced diseases and potential PC needs in primary care were eligible for inclusion. A narrative synthesis was conducted. Results From 4,127 unique articles screened, 25 reported the use or development of 10 screening tools. Most tools use prognostication and/or deterioration as a proxy for the identification of people with potential PC needs. The tools are based on a wide range of general and disease-specific indicators. The proportion of patients identified with potential PC needs across studies ranged from 0.49 to and 79%. The accuracy of five tools was assessed in eight studies; these tools differed significantly in their ability to identify patients with potential PC needs with sensitivity ranged 3–94%, and specificity ranged 26–99%. Conclusion The ability of current screening tools to identify patients with advanced diseases who are likely to have PC needs in primary care is limited. Further research is needed to identify standardised screening processes which are based not solely on predicting mortality and deterioration, but also on anticipating the needs whenever they occur and predicting the rate of functional decline in order to trigger holistic assessment to identify and address PC needs at the right time.