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Abstract
The intuitive assessment of palliative care (PC) needs and Palliative Care Screening Tool (PCST) are the assessment tools used in the early detection of patients requiring PC. However, the comparison of their prognostic accuracies has not been extensively studied. This cohort study aimed to compare the validity of intuitive assessment and PCST in terms of recognizing patients nearing end-of-life (EOL) and those appropriate for PC. All adult patients admitted to Taipei City Hospital from 2016 through 2019 were included in this prospective study. We used both the intuitive assessment of PC and PCST to predict patients’ 6-month mortality and identified those appropriate for PC. The c-statistic value was calculated to indicate the predictive accuracies of the intuition and PCST. Of 111,483 patients, 4.5% needed PC by the healthcare workers’ intuitive assessment, and 6.7% had a PCST score ≥ 4. After controlling for other covariates, a positive response ‘yes’ to intuitive assessment of PC needs [adjusted odds ratio (AOR) = 9.89; 95% confidence interval (CI) 914–10.71] and a PCST score ≥ 4 (AOR = 6.59; 95%CI 6.17–7.00) were the independent predictors of 6-month mortality. Kappa statistics showed moderate concordance between intuitive assessment and PCST in predicting patients' 6-month mortality (k = 0.49). The c-statistic values of the PCST at recognizing patients’ 6-month mortality was significantly higher than intuition (0.723 vs. 0.679; p < 0.001). As early identification of patients in need of PC could improve the quality of EOL care, our results suggest that it is imperative to screen patients’ palliative needs by using a highly accurate screening tool of PCST.
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Details
1 Taipei City Hospital, Yangming Branch, Section of Infectious Diseases, Taipei, Taiwan; National Yang-Ming University, Institute of Public Health, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017); National Taipei University of Nursing and Health Sciences, Department of Health Care Management, Taipei, Taiwan (GRID:grid.412146.4) (ISNI:0000 0004 0573 0416); Taipei City Hospital, Department of Education and Research, Taipei, Taiwan (GRID:grid.410769.d) (ISNI:0000 0004 0572 8156); University of Taipei, Taipei, Taiwan (GRID:grid.419832.5) (ISNI:0000 0001 2167 1370)
2 National Yang-Ming University, Institute of Public Health, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017); Taipei City Hospital, Department of Education and Research, Taipei, Taiwan (GRID:grid.410769.d) (ISNI:0000 0004 0572 8156); University of Taipei, Taipei, Taiwan (GRID:grid.419832.5) (ISNI:0000 0001 2167 1370)
3 National Taipei University of Nursing and Health Sciences, Department of Health Care Management, Taipei, Taiwan (GRID:grid.412146.4) (ISNI:0000 0004 0573 0416); National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017); Puli Branch of Taichung Veterans General Hospital, Division of Endocrinology and Metabolism, Department of Internal Medicine, Nantou, Taiwan (GRID:grid.410764.0) (ISNI:0000 0004 0573 0731); National Taiwan University of Sport, Department of Exercise Health Science, Taichung, Taiwan (GRID:grid.445057.7)
4 Taipei City Hospital, Department of Education and Research, Taipei, Taiwan (GRID:grid.410769.d) (ISNI:0000 0004 0572 8156)
5 National Taipei University of Nursing and Health Sciences, Department of Health Care Management, Taipei, Taiwan (GRID:grid.412146.4) (ISNI:0000 0004 0573 0416)
6 University of Taipei, Taipei, Taiwan (GRID:grid.419832.5) (ISNI:0000 0001 2167 1370); National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan (GRID:grid.260539.b) (ISNI:0000 0001 2059 7017); Taipei City Hospital, Yangming Branch, Department of Family Medicine, Taipei, Taiwan (GRID:grid.260539.b); Soochow University, Department of Psychology, Taipei, Taiwan (GRID:grid.445078.a) (ISNI:0000 0001 2290 4690)