Development of a Community-Based Palliative Care Screening Tool for Underserved Older Adults With Chronic Illnesses.
Angela Ghesquiere, Daniel S Gardner, Caitlin McAfee and 5 others
PMID 29298494WHAT IT FOUND
A short palliative care screening tool was feasible in community aging services: providers attempted screening with 46 clients, 44 agreed, 16 screened positive, and most providers found it acceptable.
Key findings
01In the pilot, 16 trained providers attempted the screening tool with 46 clients over 3 months, and 44 clients agreed to complete it.
02Of the 44 clients screened, 16 screened positive; 87.5% of those positives were referred, and 68.8% accepted referral.
03Most providers found the tool acceptable after training and at 3 months, including 93.3% at posttraining and 75.0% at follow-up saying it was easy to use.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The pilot was small: 16 providers at 2 agencies and 44 screened clients, so the findings may not apply elsewhere. Not all clients seen by trained providers were screened, which may have biased who was counted. The study collected no client-level demographic or clinical data, so it cannot show who screened positive or why. Deidentified measures prevented matching provider acceptability before and after training, and referral outcomes after acceptance were not followed. The positive-screen cutoff was based on clinical judgement and expert feedback, not a gold standard, and the tool's reliability and validity are not established. The tool omits some palliative care domains, including family support needs and cultural aspects, and health literacy was not measured. Some providers found the tool too vague or too long and were unsure how to follow up on positive screens. Cost was a rough estimate based on assumed salary and staff time, not a formal cost-effectiveness analysis.
The easy way to misread this
Do not conclude that this screening tool improves palliative care access or patient outcomes. It was a small feasibility pilot with 16 providers and 44 screened clients, no client-level follow-up, and the positive-screen cutoff was not validated against a gold standard.