Identifying Nursing Home Residents with Unmet Palliative Care Needs: A Systematic Review of Screening Tool Measurement Properties.
Connie S Cole, Jessica Roydhouse, Regina M Fink and 5 others
PMID 37030323WHAT IT FOUND
No palliative care screening tool is a validated gold standard for nursing home residents.
The included tool had low-quality evidence, so nurses should use tools to prompt assessment and team discussion.
Key findings
01No palliative care screening tool has been robustly tested in nursing homes, so there is no gold standard for this setting.
02The NEC-PAL was the only included tool, but its evidence for nursing home use was low quality.
03Three other tools were identified but excluded from quality assessment for reasons including confounding, lack of separate nursing home reporting, or inadequate development reporting.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review could not pool results because the included studies reported different measurement properties. Evidence came mainly from studies not focused on nursing home residents, so applicability to nursing homes was indirect. The NEC-PAL has not been culturally or linguistically adapted or validated for English use. Important properties such as reliability, measurement error, criterion validity, responsiveness, sensitivity and specificity were not reported. The authors only included full reports, so unpublished or abstract-only instruments may have been missed. COSMIN standards were applied to development studies reported before COSMIN, and the lowest-score method may have lowered ratings.
Declared interests
The supplied metadata lists NIH extramural and non-U.S. government research support. No author conflicts of interest are reported in the text.
The easy way to misread this
Do not conclude that the NEC-PAL is a validated screening tool for nursing home residents. The review found low-quality evidence, no robust testing of key measurement properties in nursing homes, and no gold standard.