Kidney failure: screening tools for palliative care needs - systematic review

Integrating palliative care at an early stage enhances outcomes for individuals with kidney failure; however, accurately identifying those who would benefit most remains difficult. Implementing a standardised screening method could aid in the early detection of such patients and promote timely evaluation. This review aimed to identify available screening tools designed to recognise kidney failure patients who might require palliative care and to assess their effectiveness. A systematic search was conducted in the Cochrane Library, Embase and PubMed from inception to December 2024, including studies that detailed the development or assessment of a palliative care screening tool for adult patients with kidney failure (PROSPERO registration number CRD42024524260). Among the 1745 distinct articles reviewed, 22 detailed the application and evolution of 10 screening instruments. Three tools were tailored for patients with kidney failure, while seven were applied to end-stage patients, including those with kidney disease. The tools exhibited considerable variation in their ability to detect patients with potential palliative care needs, identifying between 5% and 86% of such cases. Among 16 studies that evaluated the accuracy of eight screening tools, sensitivity values ranged from 2% to 88%, and specificity ranged from 38% to 98%. In conclusion, existing screening tools show restricted effectiveness in detecting kidney failure patients who may require palliative care, mainly depending on mortality prediction as an indicator. Future tools should focus on directly assessing symptom burden, functional status and other relevant factors, in addition to mortality risk.