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Mahura M, Karle B, Sayers L, Dick-Smith F, Elliott R. Use of the supportive and palliative care indicators tool (SPICT™) for end-of-life discussions: a scoping review. BMC Palliat Care 2024; 23:119. [PMID: 38750464 PMCID: PMC11097449 DOI: 10.1186/s12904-024-01445-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 04/25/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND In order to mitigate the distress associated with life limiting conditions it is essential for all health professionals not just palliative care specialists to identify people with deteriorating health and unmet palliative care needs and to plan care. The SPICT™ tool was designed to assist with this. AIM The aim was to examine the impact of the SPICT™ on advance care planning conversations and the extent of its use in advance care planning for adults with chronic life-limiting illness. METHODS In this scoping review records published between 2010 and 2024 reporting the use of the SPICT™, were included unless the study aim was to evaluate the tool for prognostication purposes. Databases searched were EBSCO Medline, PubMed, EBSCO CINAHL, APA Psych Info, ProQuest One Theses and Dissertations Global. RESULTS From the search results 26 records were reviewed, including two systematic review, two theses and 22 primary research studies. Much of the research was derived from primary care settings. There was evidence that the SPICT™ assists conversations about advance care planning specifically discussion and documentation of advance care directives, resuscitation plans and preferred place of death. The SPICT™ is available in at least eight languages (many versions have been validated) and used in many countries. CONCLUSIONS Use of the SPICT™ appears to assist advance care planning. It has yet to be widely used in acute care settings and has had limited use in countries beyond Europe. There is a need for further research to validate the tool in different languages.
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Affiliation(s)
| | | | - Louise Sayers
- Royal North Shore Hospital, St. Leonards, Sydney, NSW, Australia
| | | | - Rosalind Elliott
- Royal North Shore Hospital, St. Leonards, Sydney, NSW, Australia.
- University of Technology Sydney, Ultimo, Sydney, NSW, Australia.
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Limsomwong P, Ingviya T, Fumaneeshoat O. Identifying cancer patients who received palliative care using the SPICT-LIS in medical records: a rule-based algorithm and text-mining technique. BMC Palliat Care 2024; 23:83. [PMID: 38556869 PMCID: PMC10983682 DOI: 10.1186/s12904-024-01419-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/25/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Due to limited numbers of palliative care specialists and/or resources, accessing palliative care remains limited in many low and middle-income countries. Data science methods, such as rule-based algorithms and text mining, have potential to improve palliative care by facilitating analysis of electronic healthcare records. This study aimed to develop and evaluate a rule-based algorithm for identifying cancer patients who may benefit from palliative care based on the Thai version of the Supportive and Palliative Care Indicators for a Low-Income Setting (SPICT-LIS) criteria. METHODS The medical records of 14,363 cancer patients aged 18 years and older, diagnosed between 2016 and 2020 at Songklanagarind Hospital, were analyzed. Two rule-based algorithms, strict and relaxed, were designed to identify key SPICT-LIS indicators in the electronic medical records using tokenization and sentiment analysis. The inter-rater reliability between these two algorithms and palliative care physicians was assessed using percentage agreement and Cohen's kappa coefficient. Additionally, factors associated with patients might be given palliative care as they will benefit from it were examined. RESULTS The strict rule-based algorithm demonstrated a high degree of accuracy, with 95% agreement and Cohen's kappa coefficient of 0.83. In contrast, the relaxed rule-based algorithm demonstrated a lower agreement (71% agreement and Cohen's kappa of 0.16). Advanced-stage cancer with symptoms such as pain, dyspnea, edema, delirium, xerostomia, and anorexia were identified as significant predictors of potentially benefiting from palliative care. CONCLUSION The integration of rule-based algorithms with electronic medical records offers a promising method for enhancing the timely and accurate identification of patients with cancer might benefit from palliative care.
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Affiliation(s)
- Pawita Limsomwong
- Department of Family and Preventive Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
| | - Thammasin Ingviya
- Department of Family and Preventive Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
- Division of Digital Innovation and Data Analytics, Faculty of Medicine, Prince of Songkla University, Hat Yai Campus, Songkhla, 90110, Thailand
- Department of Clinical Research and Medical Data Science, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
| | - Orapan Fumaneeshoat
- Department of Family and Preventive Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
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Bouri M, Sakellari E, Krentiris D, Lagiou A. Palliative Care in the Community: The Greek Version of the Supportive and Palliative Care Indicators Tool (SPICT™). J Prim Care Community Health 2024; 15:21501319241245842. [PMID: 38605629 PMCID: PMC11010743 DOI: 10.1177/21501319241245842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/13/2024] Open
Abstract
INTRODUCTION/OBJECTIVES Systematic identification of persons with palliative care needs constitutes a major challenge for promoting palliative care in all levels of the health system, including primary care. The aim of this study was to translate, cross-culturally adapt, and content validate Supportive and Palliative Care Indicators Tool (SPICT) for use in the Greek primary care context. Secondary objectives were to probe the use of SPICT-GR in exemplary case vignettes, to discuss the clarity and comprehensibility of its content as well as the appropriateness, acceptability, and feasibility of the tool within the Greek primary care. METHODS The Greek translation and cross-cultural adaptation of SPICT™ followed World Health Organization recommendations for translation and adaptation of instruments. For this purpose a working group was set up consisting of 2 senior researchers, a primary care professional with postgraduate training in Palliative Medicine and a general practitioner (GP) with special interest in primary palliative care. Three focus groups comprised of health professionals (n = 23) working in primary care settings participated in the pilot testing phase. Participants also completed a questionnaire including rating their perceptions on tool's utility and feasibility as well as on the clarity and relevance of its items. Thematic analysis was used for focus groups discussions on how the tool was perceived and interpreted by health professionals in a Greek healthcare context and descriptive statistics for the quantitative analysis of the questionnaire data. RESULTS The majority assessed the tool as useful (65%), considered its implementation in primary care as feasible (91%) and rated its items as "relevant" or "very relevant" and "clear" or "very clear." Three themes emerged from focus groups discussions: Guiding clinical practice and facilitating collaboration; promoting comprehensive care and awareness for palliative care; applicability in and suitability for primary care. CONCLUSIONS SPICT-GR™ was identified as a practical and applicable tool for primary care, a source of guidance for the comprehensive identification of patients' palliative care needs, promoting awareness on palliative care and facilitating a shared language among health care professionals.
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Affiliation(s)
| | | | - Dimitrios Krentiris
- Health Center of Salamina, 2nd Regional Health Authority of Piraeus and the Aegean, Greece
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Davison SN, Pommer W, Brown MA, Douglas CA, Gelfand SL, Gueco IP, Hole BD, Homma S, Kazancıoğlu RT, Kitamura H, Koubar SH, Krause R, Li KC, Lowney AC, Nagaraju SP, Niang A, Obrador GT, Ohtake Y, Schell JO, Scherer JS, Smyth B, Tamba K, Vallath N, Wearne N, Zakharova E, Zúñiga C, Brennan FP. Conservative kidney management and kidney supportive care: core components of integrated care for people with kidney failure. Kidney Int 2024; 105:35-45. [PMID: 38182300 DOI: 10.1016/j.kint.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 01/07/2024]
Abstract
Integrated kidney care requires synergistic linkage between preventative care for people at risk for chronic kidney disease and health services providing care for people with kidney disease, ensuring holistic and coordinated care as people transition between acute and chronic kidney disease and the 3 modalities of kidney failure management: conservative kidney management, transplantation, and dialysis. People with kidney failure have many supportive care needs throughout their illness, regardless of treatment modality. Kidney supportive care is therefore a vital part of this integrated framework, but is nonexistent, poorly developed, and/or poorly integrated with kidney care in many settings, especially in low- and middle-income countries. To address this, the International Society of Nephrology has (i) coordinated the development of consensus definitions of conservative kidney management and kidney supportive care to promote international understanding and awareness of these active treatments; and (ii) identified key considerations for the development and expansion of conservative kidney management and kidney supportive care programs, especially in low resource settings, where access to kidney replacement therapy is restricted or not available. This article presents the definitions for conservative kidney management and kidney supportive care; describes their core components with some illustrative examples to highlight key points; and describes some of the additional considerations for delivering conservative kidney management and kidney supportive care in low resource settings.
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Affiliation(s)
- Sara N Davison
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Wolfgang Pommer
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany; Kuratorium für Dialyse und Nierentransplantation, Neu-Isenburg, Germany
| | - Mark A Brown
- Department of Renal Medicine, St George Hospital, Kogarah, Australia; School of Clinical Medicine, University of New South Wales, Kogarah, Australia
| | - Claire A Douglas
- Department of Renal Medicine, Ninewells Hospital, Dundee, Scotland, UK
| | - Samantha L Gelfand
- Division of Renal (Kidney) Medicine, Department of Psychosocial Oncology and Palliative Care, Brigham and Women's Hospital, Boston, Massachusetts, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Irmingarda P Gueco
- Section of Nephrology, The Medical City, Pasig City, National Capital Region, Philippines
| | - Barnaby D Hole
- Department of Population Health, University of Bristol, Bristol, UK
| | - Sumiko Homma
- Department of Nephrology, Koga Red Cross Hospital, Koga, Ibaraki, Japan
| | - Rümeyza T Kazancıoğlu
- Division of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | - Harumi Kitamura
- Department of Clinical Quality Management, Osaka University Hospital, Osaka, Japan
| | - Sahar H Koubar
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rene Krause
- Division of Interdisciplinary Palliative Care and Medicine, Department of Family Community and Emergency Care, University of Cape Town, Cape Town, South Africa
| | - Kelly C Li
- Department of Renal Medicine, St George Hospital, Kogarah, Australia; School of Clinical Medicine, University of New South Wales, Kogarah, Australia
| | - Aoife C Lowney
- Department of Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland; Department of Palliative Medicine, Cork University Hospital, Cork, Ireland; Department of Palliative Medicine, University College Cork, Cork, Ireland
| | - Shankar P Nagaraju
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Abdou Niang
- Nephrology Department, Cheikh Anta Diop University, Dakar, Senegal
| | - Gregorio T Obrador
- Department of Biostatistics and Public Health, Universidad Panamericana School of Medicine, Mexico City, Mexico
| | | | - Jane O Schell
- Section of Palliative Care and Medical Ethics, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jennifer S Scherer
- Department of Internal Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Brendan Smyth
- Department of Renal Medicine, St George Hospital, Kogarah, Australia; School of Clinical Medicine, University of New South Wales, Kogarah, Australia; National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Kaichiro Tamba
- Division of Palliative Care Medicine, Juchi Medical School University Hospital, Tochigi, Japan
| | - Nandini Vallath
- Department of Palliative Medicine, St Johns National Academy of Health Sciences, Bengaluru, India
| | - Nicola Wearne
- Division of Nephrology and Hypertension, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | - Carlos Zúñiga
- Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Frank P Brennan
- Kuratorium für Dialyse und Nierentransplantation, Neu-Isenburg, Germany; Department of Renal Medicine, St George Hospital, Kogarah, Australia
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Xie Z, Ding J, Jiao J, Tang S, Huang C. Screening instruments for early identification of unmet palliative care needs: a systematic review and meta-analysis. BMJ Support Palliat Care 2023:spcare-2023-004465. [PMID: 38154921 DOI: 10.1136/spcare-2023-004465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/19/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The early detection of individuals who require palliative care is essential for the timely initiation of palliative care services. This systematic review and meta-analysis aimed to (1) Identify the screening instruments used by health professionals to promote early identification of patients who may benefit from palliative care; and (2) Assess the psychometric properties and clinical performance of the instruments. METHODS A comprehensive literature search was conducted in PubMed, Embase, CINAHL, Scopus, CNKI and Wanfang from inception to May 2023. We used the COnsensus-based Standards for the Selection of Health Measurement INstruments to assess the methodological quality of the development process for the instruments. The clinical performance of the instruments was assessed by narrative summary or meta-analysis. Subgroup analyses were conducted where necessary. The quality of included studies was assessed using the Newcastle-Ottawa Scale and the Cochrane Collaboration's risk of bias assessment tool. RESULTS We included 31 studies that involved seven instruments. Thirteen studies reported the development and validation process of these instruments and 18 studies related to assessment of clinical performance of these instruments. The content validity of the instruments was doubtful or inadequate because of very low to moderate quality evidence. The pooled sensitivity (Se) ranged from 60.0% to 73.8%, with high heterogeneity (I2 of 88.15% to 99.36%). The pooled specificity (Sp) ranges from 70.4% to 90.2%, with high heterogeneity (I2 of 96.81% to 99.94%). The Supportive and Palliative Care Indicators Tool (SPICT) had better performance in hospitals than in general practice settings (Se=79.8% vs 45.3%, p=0.004; Sp=59.1% vs 97.0%, p=0.000). CONCLUSION The clinical performance of existing instruments in identifying patients with palliative care needs early ranged from poor to reasonable. The SPICT is used most commonly, has better clinical performance than other instruments but performs better in hospital settings than in general practice settings.
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Affiliation(s)
- Zhishan Xie
- Central South University, Changsha, Hunan, China
| | - Jinfeng Ding
- Central South University, Changsha, Hunan, China
| | | | - Siyuan Tang
- Central South University, Changsha, Hunan, China
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Kamita LM, Murray SA, Njiru L, Horn E, Chemutai S, Opare-Addo P. Palliative care inpatient needs: supportive and palliative care indicator tool survey in Kenya. BMJ Support Palliat Care 2023:spcare-2023-004491. [PMID: 37541780 DOI: 10.1136/spcare-2023-004491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 08/06/2023]
Affiliation(s)
| | - Scott A Murray
- Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, Primary Palliative Care Research Group, The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
| | | | - Eli Horn
- Chogoria Hospital, Chogoria, Kenya
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Oishi A, Hamano J, Boyd K, Murray S. Translation and Cross-Cultural Adaptation of the Supportive and Palliative Care Indicators Tool into Japanese: A Preliminary Report. Palliat Med Rep 2022; 3:1-5. [PMID: 36059910 PMCID: PMC9438437 DOI: 10.1089/pmr.2021.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Methods: Results: Conclusion:
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Affiliation(s)
- Ai Oishi
- Primary Care Research Unit, Graduate School of Health Data Science, Yokohama City University, Yokohama, Japan
- Address correspondence to: Ai Oishi, MD, MSc, PhD, Primary Care Research Unit, Graduate School of Health Data Science, Yokohama City University, 22-2 Seto, Kanazawa-ku, Yokohama 236-0027, Japan,
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kirsty Boyd
- Primary Palliative Care Research Group, User Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Scott Murray
- Primary Palliative Care Research Group, User Institute, University of Edinburgh, Edinburgh, United Kingdom
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Busquet-Duran X, Esteban-Perez M, Manresa-Domínguez JM, Moreno SM, Leston-Lado L, Torán-Monserrat P. Intra-rater reliability and feasibility of the HexCom advanced disease complexity assessment model. Aten Primaria 2022; 54:102343. [PMID: 35550948 PMCID: PMC9108442 DOI: 10.1016/j.aprim.2022.102343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/11/2022] [Accepted: 02/21/2022] [Indexed: 11/05/2022] Open
Abstract
Aim To study the intra-rater reliability and feasibility of the HexCom complexity assessment model by analyzing internal consistency, intra-rater reliability and response time. Design Test–retest study with a selection of 11 clinical situations that cover the full scope of situations assessed by the HexCom model and which are responded to individually. Location Home care, primary care, hospital and sociosanitary care. Two specialized palliative home care teams (PADES). Participants A total of 20 professionals comprising 10 experts in palliative home care (PADES) and 10 professionals from general palliative care (primary care, hospital and sociosanitary care). These professionals came from the fields of family medicine (5), internal medicine (2), geriatrics (2), nursing (9), psychology (1) and social work (1). Main measurements Cronbach's alpha, weighted kappa, response time. Results Cronbach's alpha of 0.91 for HexCom-Red and 0.87 for HexCom-Clin. Intra-rater reliability ranging from good to very good for HexCom-Red (kappa: 0.78–1) and from moderate to very good for HexCom-Clin (kappa: 0.58–0.91). Average response time of 0:57 for HexCom-Red and 3:80 min for HexComClin. Conclusions HexCom-Red and HexCom-Clin are reliable tools and feasible for use by all professionals involved in both general and specialized palliative care at different levels.
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Affiliation(s)
- Xavier Busquet-Duran
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Health Care Services, Catalan Institute of Health, Granollers, Barcelona, Spain; Sant Miquel Primary Care Center (CAP), Carrer de Francesc Macià i Llussà, 154, 08401 Granollers, Barcelona, Catalonia, Spain; Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain.
| | - Manel Esteban-Perez
- Home Care Program, Reus Support Team (PADES), Sant Joan de Reus University Hospital, Avinguda del Doctor Josep Laporte, 2, 43204 Reus, Tarragona, Spain
| | - Josep Maria Manresa-Domínguez
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain; Metropolitan Nord Unit of Research Support, Jordi Gol University Institute of Research in Primary Care (IDIAP), Mataró, Barcelona, Gran Via de les Corts Catalanes, 587, 08007 àtic, Catalonia, Spain
| | - Susana Martin Moreno
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Health Care Services, Catalan Institute of Health, Granollers, Barcelona, Spain; Sant Miquel Primary Care Center (CAP), Carrer de Francesc Macià i Llussà, 154, 08401 Granollers, Barcelona, Catalonia, Spain
| | - Lola Leston-Lado
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Health Care Services, Catalan Institute of Health, Granollers, Barcelona, Spain; Sant Miquel Primary Care Center (CAP), Carrer de Francesc Macià i Llussà, 154, 08401 Granollers, Barcelona, Catalonia, Spain
| | - Pere Torán-Monserrat
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain; Metropolitan Nord Unit of Research Support, Jordi Gol University Institute of Research in Primary Care (IDIAP), Mataró, Barcelona, Gran Via de les Corts Catalanes, 587, 08007 àtic, Catalonia, Spain
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