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Supportive and palliative care indicators tool prognostic value in older hospitalised patients : a prospective multicentre study

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Abstract
Background An increasing number of older patients are hospitalised. Prognostic uncertainty causes hospital doctors to be reluctant to make the switch from cure to care. The Supportive and Palliative Care Indicators Tool (SPICT) has not been validated for prognostication in an older hospitalised population. Aim To validate SPICT as a prognostic tool for risk of dying within one year in older hospitalised patients. Design Prospective multicentre study. Premorbid SPICT and 1-year survival and survival time were assessed. Setting/participants Patients 75 years and older admitted at acute geriatric (n=209) and cardiology units (CUs) (n=249) of four hospitals. Results In total, 59.3% (124/209) was SPICT identified on acute geriatric vs 40.6% (101/249) on CUs (p<0.001). SPICT-identified patients in CUs reported more functional needs and more symptoms compared to SPICT non-identified patients. On acute geriatric units, SPICT-identified patients reported more functional needs only. The HR of dying was 2.9 (95% CI 1.1 to 8.7) in SPICT-identified versus non-identified after adjustment for hospital strata, age, gender and did not differ between units. One-year mortality was 24% and 22%, respectively, on acute geriatric versus CUs (p=0.488). Pooled average sensitivity, specificity and partial area under the curve differed significantly between acute geriatric and CUs (p<0.001), respectively, 0.82 (95%CI 0.66 to 0.91), 0.49 (95%CI 0.40 to 0.58) and 0.82 in geriatric vs 0.69 (95% CI 0.42 to 0.87), 0.66 (95% CI 0.55 to 0.77) and 0.65 in CUs. Conclusions SPICT may be used as a tool to identify older hospitalised patients at risk of dying within 1 year and who may benefit from a palliative care approach including advance care planning. The prognostic accuracy of SPICT is better in older patients admitted at the acute geriatric versus the CU.
Keywords
Medicine (miscellaneous), Oncology(nursing), Medical–Surgical, General Medicine, prognosis, clinical decisions, clinical assessment, end of life care, hospital care, heart failure, SURPRISE QUESTION, FRAILTY, PEOPLE, LIFE, VALIDATION, PREDICTION, MORTALITY

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MLA
Piers, Ruth, et al. “Supportive and Palliative Care Indicators Tool Prognostic Value in Older Hospitalised Patients : A Prospective Multicentre Study.” BMJ SUPPORTIVE & PALLIATIVE CARE, 2022, doi:10.1136/bmjspcare-2021-003042.
APA
Piers, R., De Brauwer, I., Baeyens, H., Velghe, A., Hens, L., Deschepper, E., … De Saint-Hubert, M. (2022). Supportive and palliative care indicators tool prognostic value in older hospitalised patients : a prospective multicentre study. BMJ SUPPORTIVE & PALLIATIVE CARE. https://doi.org/10.1136/bmjspcare-2021-003042
Chicago author-date
Piers, Ruth, Isabelle De Brauwer, Hilde Baeyens, Anja Velghe, Lineke Hens, Ellen Deschepper, Séverine Henrard, Michel De Pauw, Nele Van Den Noortgate, and Marie De Saint-Hubert. 2022. “Supportive and Palliative Care Indicators Tool Prognostic Value in Older Hospitalised Patients : A Prospective Multicentre Study.” BMJ SUPPORTIVE & PALLIATIVE CARE. https://doi.org/10.1136/bmjspcare-2021-003042.
Chicago author-date (all authors)
Piers, Ruth, Isabelle De Brauwer, Hilde Baeyens, Anja Velghe, Lineke Hens, Ellen Deschepper, Séverine Henrard, Michel De Pauw, Nele Van Den Noortgate, and Marie De Saint-Hubert. 2022. “Supportive and Palliative Care Indicators Tool Prognostic Value in Older Hospitalised Patients : A Prospective Multicentre Study.” BMJ SUPPORTIVE & PALLIATIVE CARE. doi:10.1136/bmjspcare-2021-003042.
Vancouver
1.
Piers R, De Brauwer I, Baeyens H, Velghe A, Hens L, Deschepper E, et al. Supportive and palliative care indicators tool prognostic value in older hospitalised patients : a prospective multicentre study. BMJ SUPPORTIVE & PALLIATIVE CARE. 2022;
IEEE
[1]
R. Piers et al., “Supportive and palliative care indicators tool prognostic value in older hospitalised patients : a prospective multicentre study,” BMJ SUPPORTIVE & PALLIATIVE CARE, 2022.
@article{8713319,
  abstract     = {{Background An increasing number of older patients are hospitalised. Prognostic uncertainty causes hospital doctors to be reluctant to make the switch from cure to care. The Supportive and Palliative Care Indicators Tool (SPICT) has not been validated for prognostication in an older hospitalised population.

Aim To validate SPICT as a prognostic tool for risk of dying within one year in older hospitalised patients.

Design Prospective multicentre study. Premorbid SPICT and 1-year survival and survival time were assessed.

Setting/participants Patients 75 years and older admitted at acute geriatric (n=209) and cardiology units (CUs) (n=249) of four hospitals.

Results In total, 59.3% (124/209) was SPICT identified on acute geriatric vs 40.6% (101/249) on CUs (p<0.001). SPICT-identified patients in CUs reported more functional needs and more symptoms compared to SPICT non-identified patients. On acute geriatric units, SPICT-identified patients reported more functional needs only.

The HR of dying was 2.9 (95% CI 1.1 to 8.7) in SPICT-identified versus non-identified after adjustment for hospital strata, age, gender and did not differ between units. One-year mortality was 24% and 22%, respectively, on acute geriatric versus CUs (p=0.488). Pooled average sensitivity, specificity and partial area under the curve differed significantly between acute geriatric and CUs (p<0.001), respectively, 0.82 (95%CI 0.66 to 0.91), 0.49 (95%CI 0.40 to 0.58) and 0.82 in geriatric vs 0.69 (95% CI 0.42 to 0.87), 0.66 (95% CI 0.55 to 0.77) and 0.65 in CUs.

Conclusions SPICT may be used as a tool to identify older hospitalised patients at risk of dying within 1 year and who may benefit from a palliative care approach including advance care planning. The prognostic accuracy of SPICT is better in older patients admitted at the acute geriatric versus the CU.}},
  author       = {{Piers, Ruth and De Brauwer, Isabelle and Baeyens, Hilde and Velghe, Anja and Hens, Lineke and Deschepper, Ellen and Henrard, Séverine and De Pauw, Michel and Van Den Noortgate, Nele and De Saint-Hubert, Marie}},
  issn         = {{2045-435X}},
  journal      = {{BMJ SUPPORTIVE & PALLIATIVE CARE}},
  keywords     = {{Medicine (miscellaneous),Oncology(nursing),Medical–Surgical,General Medicine,prognosis,clinical decisions,clinical assessment,end of life care,hospital care,heart failure,SURPRISE QUESTION,FRAILTY,PEOPLE,LIFE,VALIDATION,PREDICTION,MORTALITY}},
  language     = {{eng}},
  title        = {{Supportive and palliative care indicators tool prognostic value in older hospitalised patients : a prospective multicentre study}},
  url          = {{http://dx.doi.org/10.1136/bmjspcare-2021-003042}},
  year         = {{2022}},
}

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