(P77) Systematic Review: Palliative Care Screening Tools for Nursing Home Residents

Introduction/

Objective: Palliative care in nursing homes can improve quality of life and increase patient/family satisfaction while decreasing symptoms and healthcare costs. Despite these positive outcomes, nursing home residents are not receiving palliative care services equivalent to the high prevalence of chronic life-limiting disease. A key barrier to palliative care delivery in nursing homes is the lack of a ‘gold standard’ to identify residents with unmet palliative care needs. There is no synthesis of studies regarding this topic. This systematic review aimed to determine the measurement properties of palliative care screening tools developed to identify palliative care needs among nursing home residents.

Design/Methodology: Guided by the COSMIN and JBI review methodologies we conducted a systematic review (PROSPERO registration number CRD42022345890). PubMed, Embase, CINAHL and PsycInfo were searched from inception to May 2022. Studies reporting on the development or evaluation of palliative care screening tools in nursing home residents were included. Two reviewers independently screened, selected, extracted data, and assessed risk of bias from included studies.

Results: Overall, we identified 4 instruments. These were predominately developed for a broad application across many areas of care (primary care, nursing home, hospital), with one specifically focused on nursing home residents. Most authors did not specifically report how these instruments perform in nursing home residents. Three instruments (GSF-PIG, SPICT, PCNR) were excluded due to lack of methodological rigor, confounding of results, lack of reporting on development and initial content validity or lack of testing in nursing home residents. One instrument (NEC-PAL) was included in this review and according to COSMIN criteria, the methodological quality of the included instrument was adequate.

Conclusion/

Discussion: This review highlights the paucity of validated instruments to identify palliative care needs among nursing home residents. The NEC-PAL, developed in Spanish, was identified as adequate but has not been culturally adapted and tested in English (other than translation for publication). There has been no testing of the NEC-PAL in the United States that we were able to identify. Moreover, while not developed specifically for use with nursing home residents, adaptation and validation of identified instruments may be possible. A palliative care screening tool may assist with overcoming barriers to provision of palliative care for nursing home residents through improved identification of unmet needs, ability to triage residents for limited specialty palliative care resources and improve palliative care knowledge among nursing home staff through repeated application of standardized palliative care referral criteria. Further research is needed to adapt existing tools, while addressing their deficiencies, or develop and evaluate a de novo tool.