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Original research
Do screening tools assess palliative care needs and 12-month mortality in patients admitted to hepatology in-patient wards?
  1. Joseph Low1,
  2. Catherine Carroll2,
  3. Jo Wilson2,
  4. Rachel Craig2,
  5. Shree Vadera3,
  6. Sara Cococcia3,4,
  7. Douglas Thorburn3,
  8. Patrick Stone1,
  9. Aileen Marshall3,
  10. Victoria Vickerstaff1
  1. 1Marie Curie Palliative Care Research Department, University College London, London, UK
  2. 2Palliative Care, Royal Free London NHS Trust, London, UK
  3. 3Department of Hepatology, Royal Free London NHS Trust, London, UK
  4. 4First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Lombardia, Italy
  1. Correspondence to Dr Joseph Low, Marie Curie Palliative Care Research Department, University College London, London W1W 7EP, UK; joseph.low{at}ucl.ac.uk

Abstract

Background Many liver patients have unmet palliative care needs, but liver clinicians are unclear whom to refer to specialist palliative care (SPC). The Supportive and Palliative Care Indicator Tool (SPICT) and the Bristol Prognostic Screening Tool (BPST) could help identify suitable patients, but neither has been tested for this role. This study evaluated their role as screening tools for palliative care needs and for predicting 12-month mortality.

Methods A case note review of hepatology in-patients, who were not peritransplant and post-transplant status, was conducted in one tertiary unit. Main outcomes were clinical judgement of need for SPC referral, BPST scores, SPICT attribution of caseness and 12-month survival status. Discriminatory ability of tools was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic (AUROC) curve.

Results 117 medical notes were reviewed for survival analysis, 47 of which were additionally assessed for suitability for SPC referral, using clinical judgement. SPICT (sensitivity=93%; PPV=93%; AUROC=0.933) and BPST (sensitivity=59%, PPV=79%, AUROC=0.693) demonstrated excellent and good performance, respectively, in predicting patients’ need for SPC referral. SPICT and BPST only had moderate ability at predicting death at 12 months (PPV: 54% and 56%, respectively).

Conclusion SPICT and BPST show potential as screening tools for identifying patients for referral to SPC. Further work is needed to determine how to implement these tools in a clinical setting.

  • screening
  • health service research
  • cirrhosis
  • chronic liver disease

Data availability statement

Data are available upon reasonable request. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Data availability statement

Data are available upon reasonable request. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Footnotes

  • Contributors JL, CC, JW, RC, PS, AM, DT and VV were responsible for the study concept and design; CC, RC and JW were responsible to the acquisition of the data; JL, CC, JW, RC, PS, AM, DT and VV were responsible for analysis or interpretation of the data; JL, drafted the initial manuscript; CC, JW, RC, PS, AM, DT and VV revised the manuscript critically for important intellectual content; all authors gave the final approval of the version to be published.

  • Funding This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors, but the research department responsible for conducting this study receives core funding from Marie Curie (Grant reference: MCCC-FPO-16-U). PS, JTSL and VV’s posts are supported by Marie Curie core and programme grant funding (grants MCCC-FCO-16-U and MCCC-FPO-16-U).

  • Disclaimer The funder played no role in the collection, analysis and interpretation of data, in the writing of the report; and in the decision to submit the article for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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