Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-20T13:35:55.873Z Has data issue: false hasContentIssue false

Toward a systematic approach to assessment and care planning in palliative care: A practical review of clinical tools

Published online by Cambridge University Press:  11 June 2015

Peter Hudson*
Affiliation:
Centre for Palliative Care, Melbourne, Australia University of Melbourne, Melbourne, Australia Queen's University, Belfast, Northern Ireland
Anna Collins
Affiliation:
Centre for Palliative Care, Melbourne, Australia
Adam Bostanci
Affiliation:
Centre for Palliative Care, Melbourne, Australia
Lisa Willenberg
Affiliation:
Centre for Palliative Care, Melbourne, Australia
Nikola Stephanov
Affiliation:
Centre for Palliative Care, Melbourne, Australia University of Melbourne, Melbourne, Australia School of Medicine, University of Queensland, Queensland, Australia
Jennifer Phillip
Affiliation:
Centre for Palliative Care, Melbourne, Australia University of Melbourne, Melbourne, Australia
*
Address correspondence and reprint requests to: Peter Hudson, Centre for Palliative Care, St Vincent's Hospital, P.O Box 2900, Fitzroy VICAustralia3065. E-mail: [email protected]

Abstract

Objective:

Ensuring a consistent and systematic approach to the delivery of care for people with advanced disease is a priority for palliative care services worldwide. Many clinical tools are available to aid in this process; however, they are often used sporadically, and implementation of a routine set of clinical tools to guide care planning in the specialist palliative care sector in Australia has not been achieved. This study sought to recommend key clinical tools that may assist with the assessment and care planning of specialist palliative care provision for patients and family caregivers admitted to specialist palliative care settings (home, hospital, and hospice).

Method:

A mixed-methods sequential approach over four phases was employed, involving: (1) a palliative care sector survey, (2) a systematic literature review, (3) an appraisal of identified clinical tools, and (4) a focus group with an expert panel who critiqued and endorsed a final suite of clinical tools recommended for specialist palliative care.

Results:

Twelve tools with practical relevance were recommended for use across settings of care.

Significance of Results:

Palliative services should review current practices and seek to implement this recommended suite of tools to enhance assessment and guide care delivery across care settings. Subsequent evaluation should also occur.

Type
Review Article
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Abernathy, A.P., Shelby-James, T., Fazekas, B.S., et al. (2005). The Australia-modified Karnofsky Performance Status (AKPS) scale: A revised scale for contemporary palliative care clinical practice [ISRCTN81117481]. BMC Palliative Care, 4, 7.CrossRefGoogle Scholar
Albers, G., Echteld, M.A., de Vet, H.C., et al. (2010). Evaluation of quality-of-life measures for use in palliative care: A systematic review. Palliative Medicine, 24(1), 1737.CrossRefGoogle ScholarPubMed
Ambuel, B. (2005). Taking a spiritual history, 2nd ed. Fast facts and concepts. Available from http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_019.htm.Google Scholar
Antunes, B., Harding, R. & Higginson, I.J. (2013). Implementing patient-reported outcome measures in palliative care clinical practice: A systematic review of facilitators and barriers. Palliative Medicine, 28(2), 158175.CrossRefGoogle ScholarPubMed
Aoun, S.M., Monterosso, L., Kristjanson, L.J. (2011). Measuring symptom distress in palliative care: Psychometric properties of the Symptom Assessment Scale (SAS). Journal of Palliative Medicine, 14(3), 315321.CrossRefGoogle ScholarPubMed
Bausewein, C., le Grice, C., Simon, S., et al. (2011). The use of two common palliative outcome measures in clinical care and research: A systematic review of POS and STAS. Palliative Medicine, 25(4), 304313.CrossRefGoogle ScholarPubMed
Campos, S., Zhang, L., Sinclair, E., et al. (2009). The palliative performance scale: Examining its inter-rater reliability in an outpatient palliative radiation oncology clinic. Supportive Care in Cancer, 17(6), 685690.CrossRefGoogle Scholar
CareSearch (2013). Available from http://www.caresearch.com.au/.Google Scholar
Chochinov, H.M., Hassard, T., McClement, S., et al. (2008). The Patient Dignity Inventory: A novel way of measuring dignity-related distress in palliative care. Journal of Pain and Symptom Management, 36(6), 559571.CrossRefGoogle ScholarPubMed
Chuang, R.-B., Hu, W.-Y., Chin, T.-Y., et al. (2004). Prediction of survival in terminal cancer patients in Taiwan: Constructing a prognostic scale. Journal of Pain and Symptom Management, 28(2), 115122.CrossRefGoogle ScholarPubMed
Costello, P., Wiseman, J., Douglas, I., et al. (2001). Assessing hospice inpatients with pain using numerical rating scales. Palliative Medicine, 15(3), 257258.CrossRefGoogle ScholarPubMed
Dobratz, M.C. (2004). The life closure scale: Additional psychometric testing of a tool to measure psychological adaptation in death and dying. Research in Nursing & Health, 27(1), 5262.CrossRefGoogle ScholarPubMed
Eagar, K., Watters, P., Currow, D.C., et al. (2010). The Australian Palliative Care Outcomes Collaboration (PCOC): Measuring the quality and outcomes of palliative care on a routine basis. Australian Health Review, 34(2), 186192.CrossRefGoogle ScholarPubMed
Edmonds, P.M., Stuttaford, J.M., Penny, J., et al. (1998). Do hospital palliative care teams improve symptom control? Use of a modified STAS as an evaluation tool. Palliative Medicine, 12(5), 345351.CrossRefGoogle ScholarPubMed
Ellershaw, J.E. & Murphy, D. (2005). The Liverpool Care Pathway (LCP) influencing the UK national agenda on care of the dying. International Journal of Palliative Nursing, 11(3), 132134.CrossRefGoogle ScholarPubMed
Emanuel, L.L., Alpert, H.R. & Emanuel, E.E. (2001). Concise screening questions for clinical assessments of terminal care: The Needs Near the End-of-Life Care Screening Tool. Journal of Palliative Medicine, 4(4), 465474.CrossRefGoogle ScholarPubMed
Ewing, G. & Grande, G. (2012). Development of a Carer Support Needs Assessment Tool (CSNAT) for end-of-life care practice at home: A qualitative study. Palliative Medicine, 27(3), 244256.CrossRefGoogle ScholarPubMed
Ewing, G., Todd, C., Rogers, M., et al. (2004). Validation of a symptom measure suitable for use among palliative care patients in the community: CAMPAS–R. Journal of Pain and Symptom Management, 27(4), 287299.CrossRefGoogle ScholarPubMed
FACIT. org. (2015). The Functional Assessment of Chronic Illness Therapy (FACIT) measurement system. Available from http://www.facit.org/FACITOrg.Google Scholar
Ferris, F.D., Balfour, H.M., Bowen, K., et al. (2002). A model to guide patient and family care: Based on nationally accepted principles and norms of practice. Journal of Pain and Symptom Management, 24(2), 106123.CrossRefGoogle Scholar
Ferris, F. D., Gómez-Batiste, X., Fürst, C.J., et al. (2007). Implementing quality palliative care. Journal of Pain and Symptom Management, 33(5), 533541.CrossRefGoogle ScholarPubMed
Fyllingen, E.H., Oldervoll, L.M., Loge, J.H., et al. (2009). Computer-based assessment of symptoms and mobility in palliative care: Feasibility and challenges. Journal of Pain and Symptom Management, 38(6), 827836.CrossRefGoogle ScholarPubMed
George Washington Institute for Spirituality and Health (2015). FICA Spiritual History Tool. Available from http://www.gwish.org/.Google Scholar
Glare, P., Eychmueller, S. & Virik, K. (2003 ). The use of the palliative prognostic score in patients with diagnoses other than cancer. Journal of Pain and Symptom Management, 26(4), 883885.CrossRefGoogle ScholarPubMed
Gonçalves, F., Bento, M.J., Alvarenga, M., et al. (2008). Validation of a consciousness level scale for palliative care. Palliative Medicine, 22(6), 724729.CrossRefGoogle ScholarPubMed
Groen, K.M. (2007). Pain assessment and management in end-of-life care: A survey of assessment and treatment practices of hospice music therapy and nursing professionals. Journal of Music Therapy, 44(2), 90112.CrossRefGoogle ScholarPubMed
Hardy, J.R., Haberecht, J., Maresco-Pennisi, D., et al. (2007). Audit of the care of the dying in a network of hospitals and institutions in Queensland. Internal Medicine Journal, 37(5), 315319.CrossRefGoogle Scholar
Hearn, J. & Higginson, I.J. (1999). Development and validation of a core outcome measure for palliative care: The Palliative Care Outcome Scale. Quality in Health Care, 8(4), 219227.CrossRefGoogle ScholarPubMed
Hermann, C. (2006). Development and testing of the spiritual needs inventory for patients near the end of life. Oncology Nursing Forum, 33(4), 737744.CrossRefGoogle ScholarPubMed
Hølen, J.C., Hjermstad, M.J., Loge, J.H., et al. (2006). Pain assessment tools: Is the content appropriate for use in palliative care? Journal of Pain and Symptom Management, 32(6), 567580.CrossRefGoogle ScholarPubMed
Hudson, P.L., Trauer, T., Graham, S., et al. (2010). A systematic review of instruments related to family caregivers of palliative care patients. Palliative Medicine, 24(7), 656668.CrossRefGoogle ScholarPubMed
Kaasa, T. & Wessel, J. (2001). The Edmonton Functional Assessment Tool: Further development and validation for use in palliative care. Journal of Palliative Care, 17(1), 511.CrossRefGoogle ScholarPubMed
Karnofsky, D., Abelman, W. & Craver, L. (1948). The use of nitrogen mustards in the palliative treatment of cancer. Cancer, 1, 634656.3.0.CO;2-L>CrossRefGoogle Scholar
Kirkova, J., Davis, M.P., Walsh, D., et al. (2006). Cancer symptom assessment instruments: A systematic review. Journal of Clinical Oncology, 24(9), 14591473.CrossRefGoogle ScholarPubMed
Kristjanson, L., Atwood, J. & Degner, L. (1995). Validity and reliability of the Family Inventory of Needs (FIN): Measuring the care needs of families of advanced cancer patients Journal of Nursing Measurement, 3(2), 109126.CrossRefGoogle ScholarPubMed
Lau, F., Cloutier-Fisher, D., Kuziemsky, C., et al. (2007). A systematic review of prognostic tools for estimating survival time in palliative care. Journal of Palliative Care, 23(2), 93112.CrossRefGoogle ScholarPubMed
Lunder, U., Furlan, M. & Simonic, A. (2011). Spiritual needs assessments and measurements. Current Opinion in Supportive and Palliative Care, 5, 273278.CrossRefGoogle ScholarPubMed
Mack, J.W., Nilsson, M., Balboni, T., et al. (2008). Peace, Equanimity, and Acceptance in the Cancer Experience (PEACE): Validation of a scale to assess acceptance and struggle with terminal illness. Cancer, 112(11), 25092517.CrossRefGoogle ScholarPubMed
Marie Curie Palliative Care Institute, Liverpool (2015). Available from http://www.mcpcil.org.uk/liverpool-care-pathway/.Google Scholar
McCaffery, M. & Pasero, C. (eds.) (1999). Pain: Clinical manual. St. Louis, Mosby.Google Scholar
Morita, T., Tsunoda, J., Inoue, S., et al. (2001). Communication Capacity Scale and Agitation Distress Scale to measure the severity of delirium in terminally ill cancer patients: A validation study. Palliative Medicine, 15(3), 197206.CrossRefGoogle ScholarPubMed
Munch, T.N., Strömgren, A.S., Pedersen, L., et al. (2006). Multidimensional measurement of fatigue in advanced cancer patients in palliative care: An application of the multidimensional fatigue inventory. Journal of Pain and Symptom Management, 31(6), 533541.CrossRefGoogle ScholarPubMed
National Comprehensive Cancer Network (2015). Permission requests. Available from http://www.nccn.org/about/permissions/.Google Scholar
National Consensus Project for Quality Palliative Care (2009). Clinical practice Guidelines for quality palliative care, 2nd ed. Available from http://www.nationalconsensusproject.org/.Google Scholar
Nekolaichuk, C., Watanabe, S. & Beaumont, C. (2008). The Edmonton Symptom Assessment System: A 15-year retrospective review of validation studies (1991–2006). Palliative Medicine, 22(2), 111122.CrossRefGoogle ScholarPubMed
Nikoletti, S., Porock, D., Kristjanson, L.J., et al. (2000). Performance status assessment in home hospice patients using a modified form of the Karnofsky Performance Status scale. Journal of Palliative Medicine, 3(3), 301311.CrossRefGoogle ScholarPubMed
O'Leary, N., Tiernan, E., Walsh, D., et al. (2007). The pitfalls of a systematic MEDLINE review in palliative medicine: Symptom assessment instruments. The American Journal of Hospice & Palliative Medicine, 24(3), 181184.CrossRefGoogle ScholarPubMed
Oken, M.M., Creech, R.H., Tormey, D.C., et al. (1982). Toxicity and response criteria of the Eastern Cooperative Oncology Group. American Journal of Clinical Oncology, 5(6), 649656.CrossRefGoogle ScholarPubMed
Open Grey (2011). System for information on grey literature in Europe (SIGLE). Available from http://www.opengrey.eu/.Google Scholar
Palliative Care Australia (2003). Palliative care service provision in Australia: A planning guide. Canberra: PCA.Google Scholar
Palliative Care Australia (2005). (2005). Standards for providing quality palliative care for all Australians. Canberra, PCA.Google Scholar
Palliative Care Australia (2012). Available from http://www.palliativecare.org.au/.Google Scholar
Palliative Care Outcome Collaboration (2010). PCOC Assessment Tool Kit. Available from http://ahsri.uow.edu.au/pcoc/toolkit/index.html.Google Scholar
Palliative Care Victoria (2015). Available from http://www.pallcarevic.asn.au/.Google Scholar
Petersen, M.A., Groenvold, M., Aaronson, N., et al. (2006). Item response theory was used to shorten EORTC QLQ–C30 scales for use in palliative care. Journal of Clinical Epidemiology, 59(1), 3644.CrossRefGoogle ScholarPubMed
Philip, J., Smith, W.B., Craft, P., et al. (1998). Concurrent validity of the modified Edmonton Symptom Assessment System with the Rotterdam Symptom Checklist and the Brief Pain Inventory. Supportive Care in Cancer, 6(6), 539541.CrossRefGoogle ScholarPubMed
Richards, C.T., Gisondi, M.A., Chang, C.H. (2011). Palliative care symptom assessment for patients with cancer in the emergency department: Validation of the screen for palliative and end-of-life care needs in the emergency department instrument. Journal of Palliative Medicine, 14(6), 757764.CrossRefGoogle ScholarPubMed
Richardson, A., Medina, J., Brown, V., et al. (2007). Patients' needs assessment in cancer care: A review of assessment tools. Supportive Care in Cancer, 15(10), 11251144.CrossRefGoogle Scholar
Ryan, K., Leonard, M., Guerin, S., et al. (2009). Validation of the confusion assessment method in the palliative care setting. Palliative Medicine, 23(1), 4045.CrossRefGoogle ScholarPubMed
Sands, M.B., Dantoc, B.P., Hartshorn, A., et al. (2010). Single question in delirium (SQiD): Testing its efficacy against psychiatrist interview, the confusion assessment method, and the memorial delirium assessment scale. Palliative Medicine, 24(6), 561565.CrossRefGoogle ScholarPubMed
Selman, L., Siegert, R., Harding, R., et al. (2011). A psychometric evaluation of measures of spirituality validated in culturally diverse palliative care populations. Journal of Pain and Symptom Management, 42(4), 604622.CrossRefGoogle ScholarPubMed
Stillman, M.J. & Rybicki, L.A. (2000). The Bedside Confusion Scale: Development of a portable bedside test for confusion and its application to the palliative medicine population. Journal of Palliative Medicine, 3(4), 449456.CrossRefGoogle Scholar
Stone, C.A., Tiernan, E. & Dooley, B.A. (2008). Prospective validation of the Palliative Prognostic Index in patients with cancer. Journal of Pain and Symptom Management, 35(6), 617622.CrossRefGoogle ScholarPubMed
Thekkumpurath, P., Venkateswaran, C., Kumar, M., et al. (2008). Screening for psychological distress in palliative care: A systematic review. Journal of Pain and Symptom Management, 36(5), 520528.CrossRefGoogle ScholarPubMed
van Iersel, T., Timmerman, D. & Mullie, A. (2006). Introduction of a pain scale for palliative care patients with cognitive impairment. International Journal of Palliative Nursing, 12(2), 5459.CrossRefGoogle ScholarPubMed
Vodermaier, A., Linden, W. & Siu, C. (2009). Screening for emotional distress in cancer patients: A systematic review of assessment instruments. Journal of the National Cancer Institute, 101(21), 14641488.CrossRefGoogle ScholarPubMed
Waller, A., Girgis, A., Currow, D., et al. (2008). Development of the Palliative Care Needs Assessment Tool (PC–NAT) for use by multidisciplinary health professionals. Palliative Medicine, 22(8), 956964.CrossRefGoogle Scholar
Weissman, D.E. & Meier, D.E. (2011). Identifying patients in need of a palliative care assessment in the hospital setting: A consensus report from the center to advance palliative care. Journal of Palliative Medicine, 14(1), 1723.CrossRefGoogle ScholarPubMed
Williams, B.C., Fries, B.E., Foley, W.J., et al. (1994). Activities of daily living and costs in nursing homes. Health Care Financing Review, 15(4), 117.Google ScholarPubMed
World Health Organization (WHO) (2006). WHO definition of palliative care. Available from http://www.who.int/cancer/palliative/definition/en/.Google Scholar
Zloklikovits, S., Andritsch, E., Frohlich, B., et al. (2005). Assessing symptoms of terminally ill patients by different raters: A prospective study. Palliative & Supportive Care, 3(2), 8798.CrossRefGoogle ScholarPubMed