[Identifying patients in need of general or specialised palliative care with ID-PALL]. / Identifier les patients nécessitant des soins palliatifs généraux ou spécialisés grâce à ID-PALL.

Palliative care is frequently associated with end of life and cancer, both in the general population and among healthcare professionals. ID-PALL is a new, short, easy-to-use instrument to help professionals to identify general or specialized palliative care needs in adult inpatients in different care settings. ID-PALL has already been validated in internal medicine units. ID-PALL should help professionals to discuss a suitable palliative care project, in order to maintain the best quality of life for patients and their relatives, and to involve palliative care specialists at the appropriate time. Recommendations for clinical practice are also proposed to guide professionals after the identification phase.

Que ce soit dans la population ou chez les professionnels de la santé, les soins palliatifs sont fréquemment associés à la fin de vie et au cancer. ID-PALL est un nouvel instrument court, facile d'utilisation, pour aider les professionnels à identifier les besoins de soins palliatifs généraux ou spécialisés chez les patients adultes hospitalisés dans les différents milieux de soins et déjà validé en médecine interne. ID-PALL devrait aider les professionnels à se mettre en discussion autour d'un projet de soins palliatifs adapté, afin de maintenir la meilleure qualité de vie possible pour les patients et leurs proches et également permettre d'appeler les spécialistes de soins palliatifs au moment opportun. Des recommandations pour la pratique clinique sont également proposées pour orienter les professionnels après la phase d'identification.

IDentification of patients in need of general and specialised PALLiative care (ID-PALL©): item generation, content and face validity of a new interprofessional screening instrument.

BACKGROUND: Early identification of patients requiring palliative care is a major public health concern. A growing number of instruments exist to help professionals to identify these patients, however, thus far, none have been thoroughly assessed for criterion validity. In addition, no currently available instruments differentiate between patients in need of general vs. specialised palliative care, and most are primarily intended for use by physicians. This study aims to develop and rigorously validate a new interprofessional instrument allowing identification of patients in need of general vs specialised palliative care. METHODS: The instrument development involved four steps: i) literature review to determine the concept to measure; ii) generation of a set of items; iii) review of the initial set of items by experts to establish the content validity; iv) administration of the items to a sample of the target population to establish face validity. We conducted a Delphi process with experts in palliative care to accomplish step 3 and sent a questionnaire to nurses and physicians non-specialised in palliative care to complete step 4. The study was conducted in the French and Italian-speaking regions of Switzerland. An interdisciplinary committee of clinical experts supervised all steps. RESULTS: The literature review confirmed the necessity of distinguishing between general and specialised palliative care needs and of adapting clinical recommendations to these different needs. Thirty-six nurses and physicians participated in the Delphi process and 28 were involved in the face validity assessment. The Delphi process resulted in two lists: a 7-item list to identify patients in need of general PC and an 8-item list to identify specialised PC needs. The content and face validity were deemed to be acceptable by both the expert and target populations. CONCLUSION: This instrument makes a significant contribution to the identification of patients with palliative care needs as it has been designed to differentiate between general and specialised palliative care needs. Moreover, diagnostic data is not fundamental to the use of the instrument, thus facilitating its use by healthcare professionals other than physicians, in particular nurses. Internal and criterion validity assessments are ongoing and essential before wider dissemination of the instrument.

[Identification of palliative care patients :issues and screening tools]. / Identification des patients palliatifs : enjeux et outils de dépistage.

From a health care perspective, and in order to improve the quality of care, early identification of palliative patients is a necessary step for the development of palliative care. Unfortunately, this early identification is still sub-optimal, resulting in a delayed introduction of palliative care in the patients' health care pathway. Although several tools exist to support health care professionals in this endeavour, their level of validity is incomplete, and they do not distinguish between patients in need of general versus specialised palliative care. A new tool which strives to better answer these criteria is presently being developed and validated at the CHUV.

Dans une perspective de santé publique et dans le but d'améliorer la qualité des soins, le développement des soins palliatifs passe par l'identification précoce des patients nécessitant ce type d'accompagnement. Celle-ci reste pourtant encore suboptimale, avec comme conséquence une mise en œuvre trop tardive des soins palliatifs dans la trajectoire de maladie des personnes. Différents outils existent pour soutenir les professionnels dans cette pratique même si ceux-ci ont encore un niveau de validité incomplet et ne permettent pas de distinguer les patients nécessitant des soins palliatifs généraux versus spécialisés. Un outil qui répond mieux à ces critères est en phase de développement et de validation au CHUV.

Serious medical complications in children with cancer and fever in chemotherapy-induced neutropenia: results of the prospective multicenter SPOG 2003 FN study.

BACKGROUND: Fever and chemotherapy-induced neutropenia (FN) is the most frequent potentially lethal complication of therapy in children with cancer. This study aimed to describe serious medical complications (SMC) in children with FN regarding incidence, clinical spectrum, and associated characteristics. PROCEDURE: Pediatric patients presenting with FN induced by non-myeloablative chemotherapy were observed in a prospective multicenter study. SMC was defined as potentially life-threatening complication (PLTC), transfer to the pediatric intensive care unit (PICU), or death. RESULTS: A total of 443 FN episodes were reported from 8 centers. Of these, 411 episodes were reported from 4 centers recruiting consecutively and without bias regarding the risk of complications. They were used for calculation of proportions. An SMC was reported in 23 episodes [5.6%; 95% confidence interval (CI): 3.7-8.1], usually defined by more than one criterion. These were PLTC in 13 episodes, PICU in 22, and death in 3 (mortality, 0.7%; 95% CI: 0.2-2.1). Both a delayed onset of SMC (14 of 23 episodes, 61%) and a biphasic clinical course (11 of 23, 48%) were frequently observed. In a multivariate logistic regression analysis, 4 characteristics were significantly and independently associated with the risk of SMC: diagnosis of acute myeloid leukemia, interval since chemotherapy ≤7 days, severely reduced general condition, and hemoglobin ≥9.0 g/dl at presentation. CONCLUSIONS: In children with FN, SMC were rare, and mortality was very low. Those with SMC often had a delayed onset and biphasic clinical course with secondary deterioration.

Instruments for the identification of patients in need of palliative care in the hospital setting: a systematic review of measurement properties.

OBJECTIVE: The objective of this review was to provide a comprehensive overview of the measurement properties of the available instruments used by clinicians for identifying adults in need of general or specialized palliative care in hospital settings. INTRODUCTION: Identification of patients in need of palliative care has been recognized as an area where many health care professionals need guidance. Differentiating between patients who require general palliative care and patients with more complex conditions who need specialized palliative care is particularly challenging. INCLUSION CRITERIA: We included development and validation studies that reported on measurement properties (eg, content validity, reliability, or responsiveness) of instruments used by clinicians for identifying adult patients (>18 years and older) in need of palliative care in hospital settings. METHODS: Studies published until March 2020 were searched in four databases: Embase.com, MEDLINE (Ovid), PubMed, and CINAHL (EBSCO). Unpublished studies were searched in Google Scholar, government websites, hospice websites, the Library Network of Western Switzerland, and WorldCat. The search was not restricted by language; however, only studies published in English or French were eligible for inclusion. The title and abstracts of the studies were screened by two independent reviewers against the inclusion criteria. Full-text studies were reviewed for inclusion by two independent reviewers. The quality of the measurement properties of all included studies were assessed independently by two reviewers according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. RESULTS: Out of the 23 instruments identified, four instruments were included, as reported in six studies: the Center to Advance Palliative Care (CAPC) criteria, the Necesidades Paliativas (NECPAL), the Palliative Care Screening Tool (PCST), and the Supportive and Palliative Care Indicators Tool (SPICT). The overall psychometric quality of all four instruments was insufficient according to the COSMIN criteria, with the main deficit being poor construct description during development. CONCLUSIONS: For the early identification of patients needing palliative care in hospital settings, there is poor quality and incomplete evidence according to the COSMIN criteria for the four available instruments. This review highlights the need for further development of the construct being measured. This may be done by conducting additional studies on these instruments or by developing a new instrument for the identification of patients in need of palliative care that addresses the current gaps in construct and structural validity. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020150074.

ID-PALL: An Instrument to Help You Identify Patients in Need of Palliative Care.

Palliative care is frequently associated with the end of life and cancer. However, other patients may need palliative care, and this need may be present earlier in the disease trajectory. It is therefore essential to identify at the right time patients who need palliative care and to distinguish between those in need of general palliative care and those for whom a referral to specialists is required. ID-PALL has been developed as an instrument to support professionals in this identification and to discuss a suitable palliative care project, in order to maintain the best quality of life for patients and their relatives. Recommendations for clinical practice are also proposed to guide professionals after the identification phase.

Measurement Properties of ID-PALL, A New Instrument for the Identification of Patients With General and Specialized Palliative Care Needs.

CONTEXT: To improve access to palliative care, identification of patients in need of general or specialized palliative care is necessary. To our knowledge, no available identification instrument makes this distinction. ID-PALL is a screening instrument developed to differentiate between these patient groups. OBJECTIVE: To assess the structural and criterion validity and the inter-rater agreement of ID-PALL. METHODS: In this multicenter, prospective, cross-sectional study, nurses and physicians assessed medical patients hospitalized for 2 to 5 days in two tertiary hospitals in Switzerland using ID-PALL. For the criterion validity, these assessments were compared to a clinical gold standard evaluation performed by palliative care specialists. Structural validity, internal consistency and inter-rater agreement were assessed. RESULTS: 2232 patients were assessed between January and December 2018, 97% by nurses and 50% by physicians. The variances for ID-PALL G and S are explained by two factors, the first one explaining most of the variance in both cases. For ID-PALL G, sensitivity ranged between 0.80 and 0.87 and specificity between 0.56 and 0.59. ID-PALL S sensitivity ranged between 0.82 and 0.94, and specificity between 0.35 and 0.64. A cut-off value of 1 delivered the optimal values for patient identification. Cronbach's alpha was 0.78 for ID-PALL G and 0.67 for ID-PALL S. The agreement rate between nurses and physicians was 71.5% for ID-PALL G and 64.6% for ID-PALL S. CONCLUSION: ID-PALL is a promising screening instrument allowing the early identification of patients in need of general or specialized palliative care. It can be used by nurses and physicians without a specialized palliative care training. Further testing of the finalized clinical version appears warranted.

Instruments for the identification of patients in need of palliative care: protocol for a systematic review of measurement properties.

OBJECTIVE: The objective of this review is to provide a comprehensive overview of the psychometric properties of available clinician-reported instruments developed to identify patients in need of general and specialized palliative care in acute care settings. INTRODUCTION: Identification of patients in need of palliative care has been recognized as an area where many health care professionals need guidance. Differentiating between patients who require general palliative care and patients with more complex conditions who need specialized palliative care is particularly challenging. To our knowledge, no dedicated instruments are available to date to assist health care professionals to make this identification. INCLUSION CRITERIA: Included studies will report on i) instruments aiming to identify patients in need of palliative care, ii) adult patients in need of palliative care in acute-care settings, iii) clinician-reported outcome measures, or iv) the development process or one or more of its measurement properties. Studies conducted in intensive care units, emergency departments, or nursing homes will be excluded. METHODS: We will search for studies published in English and French in a variety of sources, including Embase, Medline Ovid SP, PubMed, CINAHL EBSCO, Google Scholar, government websites, and hospice websites. All citations will be screened and selected by two independent reviewers. Data extraction, quality assessment, and syntheses of included studies will be performed according to the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) criteria. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020150074.

[A consulting partnership: a relationship to be defined]. / Entre consultance et partenariat: une relation à définir.

AIM: The goal was to explore the factors that influence adherence by internal medicine nurses (IMNs) to recommendations provided by a palliative care consult nurses (PCN) in a Swiss teaching hospital. METHOD: A qualitative phenomenological approach was applied. Following convenience sampling, IMNs were interviewed one-on-one (semi-structured questions). Two conceptual frameworks (Zay et at 1997; Sauve 2001) were used as a starting point for data coding. New categories and themes then emerged. RESULTS: Data saturation was achieved after 5 interviews. 5 categories emerged, including alterity; transparency; communication; time; and sense of ownership. Adherence requires a personal rapport and trust between the IMNs and PCNs. A focus on supporting the IMNs rather than focussing only on the patient enhances adherence. CONCLUSIONS: Our PC team needs to review its model of consultation, possibly adopting one that focuses more on supporting the primary teams. Formal and informal strategies to improve the rapport with IMN will be sought. Awareness by the PCN of the inferiority felt by the IMNs may enhance rapport building.