Validation of the Palliative Care and Rapid Emergency Screening (P-CaRES) Tool in Germany

Background/Objectives: The "Palliative Care and Rapid Emergency Screening Tool" (P-CaRES) is used to identify patients with palliative needs in the emergency department. This study aims to translate, adapt, and validate the P-CaRES tool for the German healthcare context. Methods: This is a monocentric, non-interventional, retrospective study conducted in the emergency department of the University Hospital Essen, Germany. After a structured translation process, the tool's face and content validity were evaluated using questionnaires completed by healthcare workers. Construct validity was established by comparing the results with the German-validated Supportive and Palliative Care Indicators Tool (SPICT). A palliative care physician blinded to the tool, independently assessed the screened patients, and made recommendations on the appropriateness of palliative care referrals. Results: Two hundred eighty-nine emergency department visits were examined. In addition, a total of 26 healthcare professionals were surveyed. 258 screenings were conducted, with P-CaRES identifying 50 positive cases (19.4%). Agreement between SPICT and P-CaRES was 88.4% (kappa: 0.67, 95% confidence interval (CI): [0.56, 0.78]), showing 64.7% sensitivity and 96.8% specificity. Expert comparison yielded 85.5% agreement (kappa: 0.54, 95% CI: [0.41, 0.68]), with 64.0% sensitivity and 90.8% specificity. Face and content validity showed strong agreement regarding the tool's design, including its comprehensibility, applicability, ease of use, and precision, as well as its usefulness in referring patients to a specialized palliative care team. Conclusions: The study successfully validated a cultural and linguistic equivalent German version of the P-CaRES tool. Further research is necessary to assess the tool's effectiveness in clinical practice.