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Background
To optimise quality of life for patients with life-threatening disease, palliative care should run in parallel with potentially curative or disease-modifying treatment. 1-3 In studies of earlier integration of palliative care with disease-oriented management, palliative patients have reported improved satisfaction with care, there are less acute interventions and patients are more likely to die at home. 4 5
Essential steps for good palliative care provision include timely identification of patients, assessment of their care needs and planning of care. 6 The patient's general practitioner (GP) is well placed to have an important role in this process. There is some evidence that where the GP is part of a team, palliative care appeared to improve. 7 8 Yet patients with advanced chronic disease may have a medical specialist actively treating their disease, which makes proactive palliative care planning a challenge for GPs.
Better and more timely identification of non-malignant patients for palliative care has been called for over a decade. 9 However, identifying when a palliative care approach should be implemented can be challenging, particularly for patients with non-malignant diseases such as advanced chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF). 10 11 Such tools should ideally include the patient's perspective. In a recent study in Scotland, 60% of patients who died from cancer were listed on the practice palliative care register (PCR), while only 20% for patients who had died with other long-term conditions such as heart failure, dementia and COPD had been identified. 12 The lack of prognostic indicators and clinical triggers to identify a 'limited life prognosis' appeared to be the most important barrier in applying palliative care in primary care. 13
There are few specific objective identification criteria or validated tools to support primary care providers in this task of identifying a transition point to start integrating palliative care. 14 15 In 2008, a literature review did not identify any validated tools that predict the optimal timing to initiate palliative care services. 16 However, the use of a structured identification tool has been shown to be an approach by which more patients with non-malignant diseases could benefit from palliative care. 17 Therefore, we set out to identify what identification tools were currently known about internationally for GPs to...