Identification of people for palliative care in primary health care: integrative review

Paraizo-Horvath, Camila Maria Silva; Fernandes, Daiane de Souza; Russo, Tatiana Mara da Silva; Souza, Ana Carolina de; Silveira, Renata Cristina de Campos Pereira; Galvão, Cristina Maria; Mendes, Karina Dal Sasso

doi:10.1590/1413-81232022279.01152022EN

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REVIEW • Ciênc. saúde coletiva 27 (09) • Sept 2022 • https://doi.org/10.1590/1413-81232022279.01152022EN copy

Identification of people for palliative care in primary health care: integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aims to analyze the evidence available in the literature on the process of identifying adults and elderly people who can benefit from palliative care (PC) in primary health care (PHC). This is an integrative literature review carried out in PubMed, CINAHL, LILACS, Web of Science, and Embase. Eight studies were selected, in which different instruments and methods were distinguished with the purpose of identifying people who can benefit from PC in the context of PHC. The incorporation of these instruments into clinical practice is urgent in order to increase the reach and effectiveness of the services offered by health professionals, considering the current demographic and epidemiological profile that points to the increase of people with a potential need for PC. Different instruments have been successfully used to identify PC in the context of PHC. However, some have weaknesses, such as the fact that they only allow the identification of people with oncological diseases, leaving out other health conditions, which reinforces the need for further studies on this topic.

Key words:
Palliative care; Primary health care; Comprehensive health care; Health policy; Review

Primary Study	Aim	Method	Investigated population	Level of evidence
Afshar et al.¹⁰10 Afshar K, Wiese B, Schneider N, Müller-Mundt G. Systematic identification of critically ill and dying patients in primary care using the German version of the Supportive and Palliative Care Indicators Tool (SPICT-DE). Ger Med Sci 2020;18:Doc02. (2020)	To investigate the feasibility and practicality of the German version of the Supportive and Palliative Care Indicators Tool (SPICT-DE) for the systematic identification of these patients in a general clinic.	Descriptive study	10 general practitioners participated, from both urban and rural regions, with different professional experience in Family and Community Medicine, with and without additional qualification in palliative care.	VI^* (clinical question/diagnosis)
Trapero et al. ²² (2019)	To identify, through the application of the NECPAL tool in the field of Primary Health Care in Segovia, people with advanced chronic diseases with a potential need for palliative care.	Observational, descriptive, longitudinal, and prospective study	Population sample from the health area that attended to basic health units from December 1, 2014, to May 16, 2015.	VI^* (clinical question/diagnosis)
Larrañaga et al.²³23 Larrañaga I, Millas J, Soto-Gordoa M, Arrospide A, San Vicente R, Irizar M, Lanzeta I, Mar J. Impacto de la identificación de pacientes en un programa de cuidados paliativos del País Vasco. Aten Primaria 2019; 51(2):80-90. (2019)	To evaluate, in terms of improvements in processes and economic impacts, the implementation in two integrated healthcare organizations from the palliative care program, focused on the identification of the patient.	Cross-sectional study. The necessary information was extracted from a databank	Patients who died (oncological or not) in 2012 (control group) and in 2015 (intervention group).	VI^* (clinical question/diagnosis)
Scaccabarozzi et al. ²⁴ (2017)	To illustrate the characteristics of the patients, focused on their early identification by general practitioners and to analyze the care process in home palliative care services.	Multicenter prospective observational study	94 general practitioners from 10 different units of home palliative care.	IV^** (clinical question/prognosis)
Urquhart et al.²⁵25 Urquhart R, Kotecha J, Kendell C, Martin M, Han H, Lawson B, Tschupruk C, Marshall EG, Bennett C, Burge F. Stakeholders' views on identifying patients in primary care at risk of dying: a qualitative descriptive study using focus groups and interviews. Br J Gen Pract 2018; 68(674):e612-e620. (2018)	To explore the acceptability and the implications of use of an electronic medical record algorithm based on the PHC to help service providers to identify patients at risk of a decline in health and death.	Qualitative study	The participants were 29 health professionals (doctors, nurses, and social assistants), managers, and policymakers who worked in PHC, palliative care, geriatrics, long-term care, and home care in Nova Scotia and Ontario (Canada).	II^***(clinical question/meaning)
Van der Plas et al. ⁹ (2018)	To study the effects of the implementation of the PaTz groups and provide additional analyses about two important elements: PaTz records and patient discussions.	Quantitative study (with pre and post-assessment)	37 PaTz groups	VI^**** (clinical question/intervention)
Mason et al.⁸8 Mason B, Boyd K, Steyn J, Kendall M, Macpherson S, Murray SA. Computer screening for palliative care needs in primary care: a mixed-methods study. Br J Gen Pract 2018; 68(670):e360-e369. (2018)	To refine and test the usefulness of the general practitioners’ practices who regularly execute their own computer research based on barcodes to aid in identifying patients for the palliative care approach.	Mixed study	8 female practitioners 8 male practitioners and 10 patients were interviewed	Not applicable
Hamano et al.²⁶26 Hamano J, Oishi A, Kizawa Y. Identified Palliative Care Approach Needs with SPICT in Family Practice: A Preliminary Observational Study. J Palliat Med 2018; 21(7):992-998. (2018)	To explore the prevalence and characteristics of the patients from family health care who need the palliative care approach, according to that defined by the Supportive and Palliative Care Indicators Tool (SPICT, April 2015) in Japan.	Single center cross-sectional study	87 patients	IV^** (clinical question/prognosis)

Critical review of quantitative studies		Trapero et al.²² (2019)	Larrañaga et al.²³ (2019)	Afshar et al.¹⁰ (2020)	Van der Plas et al.⁹ (2018)	Scaccabarozzi et al.²⁴ (2017)	Hamano et al.²⁶ (2018)
Aim	Is the aim clear?	Y	Y	Y	Y	Y	Y
Literature	Was a relevant literature review conducted on this theme?	Y	Y	N	N	N	Y
Design	Does it describe the design (RCT/cohort/single case/before and after/case-control/cross-sectional/case study/longitudinal)	Y	Y	Y	Y	Y	Y
Sample	Sample described in detail	Y	Y	Y	N	Y	Y
Sample	Justification presented for the sample size	Y	N	Y	N	Y	Y
Outcomes	Reliable outcome measurements	NI	Y	Y	N	Y	Y
Outcomes	Valid outcome measurements	NI	NI	Y	N	Y	Y
Intervention	Intervention described in detail	N	Y	Y	NI	NI	NI
	Contamination was avoided	Y	Y	Y	NA	NA	NA
	Simultaneous intervention was avoided	Y	Y	Y	NA	NA	NA
Results	Results reported in terms of statistical significance	N	N	Y	Y	Y	NA
	Adequate methods of analysis	Y	Y	Y	Y	Y	Y
	Clinical importance was reported	Y	Y	Y	Y	Y	Y
	Reports from participants who abandoned the study	N	Y	N	N	N	N
Conclusions and clinical implications	Coherent conclusions reached with the methods and obtained results	Y	Y	Y	Y	Y	Y

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[1] Collaborations

CMS Paraizo-Horvath: conception, planning, analysis, interpretation and writing of the work; critical review of the work. DS Fernandes, TMS Russo and AC Souza: conception, planning, analysis, interpretation and writing of the work. RCCP Silveira: analysis, interpretation, final review of the work. CM Galvão: analysis, interpretation, final review of the work. KDS Mendes: conception, planning, analysis, interpretation, writing of the work; final review of the work.