Validation of a Simple Screening Tool for Identifying Unmet Palliative Care Needs in Patients With Cancer

The National Comprehensive Cancer Network (NCCN) palliative care (PC) guideline recommends PC screening for all patients and provides criteria for identifying those in need of referral to a PC specialist. This two-step process has not yet been validated as accurately identifying patients in need. The aim of this study was to validate a simplified method for screening and referral based on the existing guideline criteria.

An 11-item screening tool was created, with scores from 0 to 14. Content validity was assessed by a panel of local PC experts. Construct and criterion validities were evaluated using data obtained from a previous study of guideline-based screening and referral.

Content validity of the tool was high, with eight items rated as essential. Patients who were closer to death had significantly higher scores, indicating its construct validity. Scores were also higher in patients who were identified as needing a consult and in those who had worse pain and other symptoms, indicating its criterion validity. Using a score of ≥ 5 as the trigger, approximately one third of hospitalized patients in the previous study would have been referred to a PC specialist, twice as many as occurred when the attending oncologist relied on his or her clinical judgment.

The tool seems to be a valid method for identifying patients with cancer with complex PC needs who would benefit from a PC consult. Reliability testing, external validation, and demonstration of the utility of the tool as a decision aid all await confirmation.