This paper explores the critical role of prognostication tools in identifying high-risk hospitalized older adults who may benefit from palliative care. With an ageing population and increasing prevalence of chronic illnesses, the demand for patient-centered healthcare is paramount. The study evaluates three key tools—the Palliative Performance Scale, CARING criteria, and Palliative Care Rapid Emergency Screening tool. Each tool is analyzed for its psychometric properties, advantages, and limitations. Despite their strengths and limitations, these tools emerge as crucial screening tools for identifying older adults at heightened mortality risk within one year of hospital admission. Our paper calls for ongoing research to adapt and validate existing tools, ensuring their applicability across diverse clinical settings and patient populations.
BabcockM.Gould KuntzJ.KowalskyD.CalitriN.KennyA. M. (2016). The palliative performance scale predicts three- and six-month survival in older adult patients admitted to the hospital through the emergency department. Journal of Palliative Medicine, 19(10), 1087–1091. https://doi.org/10.1089/jpm.2016.0011
4.
BaikD.RussellD.JordanL.DooleyF.BowlesK. H.Masterson CreberR. M. (2018). Using the palliative performance scale to estimate survival for patients at the End of life: A Systematic Review of the Literature. Journal of Palliative Medicine, 21(11), 1651–1661. https://doi.org/10.1089/jpm.2018.0141
5.
BernabeiR.LandiF.GambassiG.SgadariA.ZuccalaG.MorV.RubensteinL. Z.CarboninP. (1998). Randomised trial of impact of model of integrated care and case management for older people living in the community. BMJ, 316(7141), 1348–1351. https://doi.org/10.1136/bmj.316.7141.1348
6.
BernatJ. L. (2004). Ethical aspects of determining and communicating prognosis in critical care. Neurocritical Care, 1(1), 107–117. https://doi.org/10.1385/NCC:1:1:107
7.
BowmanJ.GeorgeN.BarrettN.AndersonK.Dove-MaguireK.BairdJ. (2016). Acceptability and reliability of a novel palliative care screening tool among emergency department providers. Academic Emergency Medicine, 23(6), 694–702. https://doi.org/10.1111/acem.12963
BrumleyR.EnguidanosS.JamisonP.SeitzR.MorgensternN.SaitoS.McIlwaneJ.HillaryK.GonzalezJ. (2007). Increased satisfaction with care and lower costs: Results of a randomized trial of in-home palliative care. Journal of the American Geriatrics Society, 55(7), 993–1000. https://doi.org/10.1111/j.1532-5415.2007.01234.x
10.
ChristakisN. A.LamontE. B. (2000). Extent and determinants of error in doctors’ prognoses in terminally ill patients: Prospective cohort study. BMJ, 320(7233), 469–472. https://doi.org/10.1136/bmj.320.7233.469
11.
ChuC.EngelsY.SuhS. Y.KimS. H.WhiteN. (2023). Should the surprise question be used as a prognostic tool for people with life-limiting illnesses?Journal of Pain and Symptom Management, 66(3), e437–e441. https://doi.org/10.1016/j.jpainsymman.2023.05.003
12.
ConnorS. R. (2017). Hospice and palliative care: The essential guide (Third edition. ed.). Routledge.
13.
CrawleyL. M.MarshallP. A.LoB.KoenigB. A., & End-of-Life Care Consensus, P. (2002). Strategies for culturally effective end-of-life care. Annals of Internal Medicine, 136(9), 673–679. https://doi.org/10.7326/0003-4819-136-9-200205070-00010
14.
CrimminsE. M.Beltran-SanchezH. (2011). Mortality and morbidity trends: Is there compression of morbidity?The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 66(1), 75–86. https://doi.org/10.1093/geronb/gbq088
15.
DavisM.VanenkevortE.YoungA.WojtowiczM.LagermanB.GuptaM.AdonizioC.PanikkarR. (2023). Validation of the surprise question and the development of a multivariable model. Journal of Pain and Symptom Management, 65(5), 456–464. https://doi.org/10.1016/j.jpainsymman.2023.01.015
16.
DeVonH. A.BlockM. E.Moyle-WrightP.ErnstD. M.HaydenS. J.LazzaraD. J.SavoyS. M.Kostas-PolstonE. (2007). A psychometric toolbox for testing validity and reliability. Journal of Nursing Scholarship, 39(2), 155–164. https://doi.org/10.1111/j.1547-5069.2007.00161.x
17.
DownarJ.GoldmanR.PintoR.EnglesakisM.AdhikariN. K. (2017). The “surprise question” for predicting death in seriously ill patients: A systematic review and meta-analysis. Canadian Medical Association Journal, 189(13), E484–E493. https://doi.org/10.1503/cmaj.160775
FerrellB. R.TemelJ. S.TeminS.AlesiE. R.BalboniT. A.BaschE. M.FirnJ. I.PaiceJ. A.PeppercornJ. M.PhillipsT.StovallE. L.ZimmermannC.SmithT. J. (2017). Integration of palliative care into standard oncology care: American society of clinical oncology clinical practice guideline update. Journal of Clinical Oncology, 35(1), 96–112. https://doi.org/10.1200/JCO.2016.70.1474
20.
FerrellB. R.TwaddleM. L.MelnickA.MeierD. E. (2018). National consensus project clinical practice guidelines for quality palliative care guidelines, 4th edition. Journal of Palliative Medicine, 21(12), 1684–1689. https://doi.org/10.1089/jpm.2018.0431
21.
FischerS. M.GozanskyW. S.SauaiaA.MinS. J.KutnerJ. S.KramerA. (2006). A practical tool to identify patients who may benefit from a palliative approach: The CARING criteria. Journal of Pain and Symptom Management, 31(4), 285–292. https://doi.org/10.1016/j.jpainsymman.2005.08.012
22.
GardinerC.CobbM.GottM.IngletonC. (2011). Barriers to providing palliative care for older people in acute hospitals. Age and Ageing, 40(2), 233–238. https://doi.org/10.1093/ageing/afq172
23.
GeorgeN.BarrettN.McPeakeL.GoettR.AndersonK.BairdJ. (2015). Content validation of a novel screening tool to identify emergency department patients with significant palliative care needs. Academic Emergency Medicine, 22(7), 823–837. https://doi.org/10.1111/acem.12710
GlareP.VirikK.JonesM.HudsonM.EychmullerS.SimesJ.ChristakisN. (2003). A systematic review of physicians’ survival predictions in terminally ill cancer patients. Bmj, 327(7408), 195–198. https://doi.org/10.1136/bmj.327.7408.195
26.
HeW.GoodkindD.KowalP. R. (2016). An aging world: 2015. In: United States Census Bureau Washington, DC.
27.
HeadB.RitchieC. S.SmootT. M. (2005). Prognostication in hospice care: Can the palliative performance scale help?Journal of Palliative Medicine, 8(3), 492–502. https://doi.org/10.1089/jpm.2005.8.492
HoF.LauF.DowningM. G.LesperanceM. (2008). A reliability and validity study of the Palliative Performance Scale. BMC Palliative Care, 7, 10. https://doi.org/10.1186/1472-684X-7-10
30.
HuiD. (2015). Prognostication of survival in patients with advanced cancer: Predicting the unpredictable?Cancer Control, 22(4), 489–497. https://doi.org/10.1177/107327481502200415
31.
HuiD.De La CruzM.MoriM.ParsonsH. A.KwonJ. H.Torres-VigilI.KimS. H.DevR.HutchinsR.LiemC.KangD. H.BrueraE. (2013). Concepts and definitions for “supportive care,” “best supportive care,” “palliative care,” and “hospice care” in the published literature, dictionaries, and textbooks. Supportive Care in Cancer, 21(3), 659–685. https://doi.org/10.1007/s00520-012-1564-y
32.
HuiD.PaivaC. E.Del FabbroE. G.SteerC.NaberhuisJ.van de WeteringM.Fernandez-OrtegaP.MoritaT.SuhS. Y.BrueraE.MoriM. (2019). Prognostication in advanced cancer: Update and directions for future research. Supportive Care in Cancer, 27(6), 1973–1984. https://doi.org/10.1007/s00520-019-04727-y
33.
Institute of Medicine. (2008). Retooling for an Aging America: Building the Health Care Workforce. Washington, DC: The National Academies Press. https://doi.org/10.17226/12089
34.
KavalieratosD.CorbelliJ.ZhangD.Dionne-OdomJ. N.ErnecoffN. C.HanmerJ.HoydichZ. P.IkejianiD. Z.Klein-FedyshinM.ZimmermannC.MortonS. C.ArnoldR. M.HellerL.SchenkerY. (2016). Association between palliative care and patient and caregiver outcomes: A systematic review and meta-analysis. JAMA, 316(20), 2104–2114. https://doi.org/10.1001/jama.2016.16840
35.
LamontE. B.ChristakisN. A. (2002). Physician factors in the timing of cancer patient referral to hospice palliative care. Cancer, 94(10), 2733–2737. https://doi.org/10.1002/cncr.10530
36.
MayP.GarridoM. M.CasselJ. B.KelleyA. S.MeierD. E.NormandC.SmithT. J.StefanisL.MorrisonR. S. (2015). Prospective cohort study of hospital palliative care teams for inpatients with advanced cancer: Earlier consultation is associated with larger cost-saving effect. Journal of Clinical Oncology, 33(25), 2745–2752. https://doi.org/10.1200/JCO.2014.60.2334
37.
MeierD. E.IsaacsS. L.HughesR. (Eds.). (2010). Palliative Care: Transforming the Care of Serious Illness (1st ed.). San Francisco: Jossey-Bass.
38.
Ni ChroininD.GoldsburyD. E.BeveridgeA.DavidsonP. M.GirgisA.InghamN.PhillipsJ. L.WilkinsonA. M.InghamJ. M.O'ConnellD. L. (2018). Health-services utilisation amongst older persons during the last year of life: A population-based study. BMC Geriatrics, 18(1), 317. https://doi.org/10.1186/s12877-018-1006-x
39.
O'ConnellD. L.GoldsburyD. E.DavidsonP.GirgisA.PhillipsJ. L.PizaM.WilkinsonA.InghamJ. M. (2014). Acute hospital-based services utilisation during the last year of life in New South Wales, Australia: Methods for a population-based study. BMJ Open, 4(3), e004455. https://doi.org/10.1136/bmjopen-2013-004455
40.
OlajideO.HansonL.UsherB. M.QaqishB. F.SchwartzR.BernardS. (2007). Validation of the palliative performance scale in the acute tertiary care hospital setting. Journal of Palliative Medicine, 10(1), 111–117. https://doi.org/10.1089/jpm.2006.0125
41.
PaskeJ. R. T.DeWittS.HicksR.SemmensS.VaughanL. (2021). Palliative care and rapid emergency screening tool and the palliative performance scale to predict survival of older adults admitted to the hospital from the emergency department. The American Journal of Hospice & Palliative Care, 38(7), 800–806. https://doi.org/10.1177/1049909120960713
42.
RadbruchL.De LimaL.KnaulF.WenkR.AliZ.BhatnagharS.BlanchardC.BrueraE.BuitragoR.BurlaC.CallawayM.MunyoroE. C.CentenoC.ClearyJ.ConnorS.DavaasurenO.DowningJ.FoleyK.GohC. … PastranaT. (2020). Redefining palliative care-A new consensus-based definition. Journal of Pain and Symptom Management, 60(4), 754–764. https://doi.org/10.1016/j.jpainsymman.2020.04.027
SantivasiW. L.PartainD. K.WhitfordK. J. (2020). The role of geriatric palliative care in hospitalized older adults. Hosp Pract (1995), 48(sup1), 37–47. https://doi.org/10.1080/21548331.2019.1703707
45.
SeedhomA. E.KamalN. N. (2017). The palliative performance scale predicts survival among emergency department patients, minia, Egypt. Indian Journal of Palliative Care, 23(4), 368–371. https://doi.org/10.4103/IJPC.IJPC_50_17
46.
SiontisG. C.TzoulakiI.IoannidisJ. P. (2011). Predicting death: An empirical evaluation of predictive tools for mortality. Archives of Internal Medicine, 171(19), 1721–1726. https://doi.org/10.1001/archinternmed.2011.334
47.
SommovillaJ.KopeckyK. E.CampbellT. (2019). Discussing prognosis and shared decision-making. The Surgical Clinics of North America, 99(5), 849–858. https://doi.org/10.1016/j.suc.2019.06.011
48.
ThomasJ. M.CooneyL. M.Jr.FriedT. R. (2013). Systematic review: Health-related characteristics of elderly hospitalized adults and nursing home residents associated with short-term mortality. Journal of the American Geriatrics Society, 61(6), 902–911. https://doi.org/10.1111/jgs.12273
49.
WalshR. I.MitchellG.FrancisL.van DrielM. L. (2015). What diagnostic tools exist for the early identification of palliative care patients in general practice? A systematic review. Journal of Palliative Care, 31(2), 118–123. https://doi.org/10.1177/082585971503100208
50.
WeissmanD. E.MeierD. 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), 17–23. https://doi.org/10.1089/jpm.2010.0347
51.
YoungwerthJ.MinS. J.StatlandB.AllynR.FischerS. (2013). Caring about prognosis: A validation study of the caring criteria to identify hospitalized patients at high risk for death at 1 year. Journal of Hospital Medicine (Online), 8(12), 696–701. https://doi.org/10.1002/jhm.2107
52.
ZimmermannC.SwamiN.KrzyzanowskaM.HannonB.LeighlN.OzaA.MooreM.RydallA.RodinG.TannockI.DonnerA.LoC. (2014). Early palliative care for patients with advanced cancer: A cluster-randomised controlled trial. Lancet, 383(9930), 1721–1730. https://doi.org/10.1016/S0140-6736(13)62416-2
