Palliative care screening tool for ICU patients may facilitate decision making

A research team at the University of North Carolina at Chapel Hill (UNC-Chapel Hill) says it has developed a screening tool to rapidly identify patients who may benefit from palliative care consultations or goals of care discussions.

The tool is designed to assist the decision making processes and increase awareness around palliative care in the Surgical Intensive Care Unit (SICU).

Research findings, presented at the Scientific Forum during the American College of Surgeons (ACS) Clinical Congress 2022, show the screening tool successfully identified SICU patients who were later deemed candidates for palliative care by their medical team.  

Trista Day Snyder Reid, an Assistant Professor of Surgery at UNC Health and the study’s Medical Adviser, said she often sees medical teams and families make agonising decisions for patients in the SICU.

Unfortunately, a medical team may hesitate to collectively identify appropriate patients or may refer patients to palliative care late in their SICU stay, increasing the burden and stress on the patient and their families.  

Trista Day Snyder Reid said, ‘One of the things that we found at our institution was sometimes we would involve palliative care, but it would happen way down the line when the patient had been in the SICU for a long time already. 

‘We want palliative care discussions to be happening sooner. And even if we’re not involving palliative care, we want goals of care discussions to happen early so the family has a rapport with the medical team and understands that their family member is really sick.’

Research has shown that offering palliative care consultations early in an ICU stay can improve quality of life and even reduce the lengths of stay in the ICU.

However, integrating palliative care into hospital systems remains challenging due to a lack of resources and insufficient training, among other factors. 

The UNC researchers initially developed a screening tool with 12 yes/no’ questions with input from SICU and palliative care physicians, nurses, and advanced practice providers.

Fourth-year medical students at UNC-Chapel Hill completed the questionnaire after receiving feedback from the SICU medical team. Questions where the team answered ‘yes’ was deemed a positive indicator that the patient would benefit from a palliative care consultation.  

Three iterations of the screening tool were developed using the Plan-Do-Study-Act (PDSA) method before selecting three questions that the researchers found best correlated with a positive indicator. 

Screening tools from 282 patients in the SICU were recorded – 22 patients were identified, and they all received referrals for palliative care.

Each patient could be screened in about three seconds; all patients in the SICU could be screened in about 30 seconds. The tool did not increase the burden on the palliative care team at UNC Health. 

‘The hope is that by using this screening tool, decisions traditionally made very late in the patient’s SICU stay, could be made much earlier,’ said Lead Author of the study Victoria Herdman. ‘Physicians, physician assistants, nurse practitioners and nurses know early on who needs palliative care but sometimes that’s hard to jump into early in the stay. This screening tool is a way to guide everyone into it easier.’

Photo by Olga Kononenk