Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel

Assessment of Clinical Palliative Care Trigger Status vs Actual Needs Among Critically Ill Patients and Their Family Members.

Publication ,  Journal Article
Cox, CE; Ashana, DC; Haines, KL; Casarett, D; Olsen, MK; Parish, A; O'Keefe, YA; Al-Hegelan, M; Harrison, RW; Naglee, C; Katz, JN; Frear, A ...
Published in: JAMA Netw Open
January 4, 2022

IMPORTANCE: Palliative care consultations in intensive care units (ICUs) are increasingly prompted by clinical characteristics associated with mortality or resource utilization. However, it is not known whether these triggers reflect actual palliative care needs. OBJECTIVE: To compare unmet needs by clinical palliative care trigger status (present vs absent). DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was conducted in 6 adult medical and surgical ICUs in academic and community hospitals in North Carolina between January 2019 and September 2020. Participants were consecutive patients receiving mechanical ventilation and their family members. EXPOSURE: Presence of any of 9 common clinical palliative care triggers. MAIN OUTCOMES AND MEASURES: The primary outcome was the Needs at the End-of-Life Screening Tool (NEST) score (range, 0-130, with higher scores reflecting greater need), which was completed after 3 days of ICU care. Trigger status performance in identifying serious need (NEST score ≥30) was assessed using sensitivity, specificity, positive and negative likelihood ratios, and C statistics. RESULTS: Surveys were completed by 257 of 360 family members of patients (71.4% of the potentially eligible patient-family member dyads approached) with a median age of 54.0 years (IQR, 44-62 years); 197 family members (76.7%) were female, and 83 (32.3%) were Black. The median age of patients was 58.0 years (IQR, 46-68 years); 126 patients (49.0%) were female, and 88 (33.5%) were Black. There was no difference in median NEST score between participants with a trigger present (45%) and those with a trigger absent (55%) (21.0; IQR, 12.0-37.0 vs 22.5; IQR, 12.0-39.0; P = .52). Trigger presence was associated with poor sensitivity (45%; 95% CI, 34%-55%), specificity (55%; 95% CI, 48%-63%), positive likelihood ratio (1.0; 95% CI, 0.7-1.3), negative likelihood ratio (1.0; 95% CI, 0.8-1.2), and C statistic (0.50; 95% CI, 0.44-0.57). CONCLUSIONS AND RELEVANCE: In this cohort study, clinical palliative care trigger status was not associated with palliative care needs and no better than chance at identifying the most serious needs, which raises questions about an increasingly common clinical practice. Focusing care delivery on directly measured needs may represent a more person-centered alternative.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

JAMA Netw Open

DOI

EISSN

2574-3805

Publication Date

January 4, 2022

Volume

5

Issue

1

Start / End Page

e2144093

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Prospective Studies
  • Predictive Value of Tests
  • Palliative Care
  • North Carolina
  • Needs Assessment
  • Middle Aged
  • Male
  • Intensive Care Units
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Cox, C. E., Ashana, D. C., Haines, K. L., Casarett, D., Olsen, M. K., Parish, A., … Docherty, S. L. (2022). Assessment of Clinical Palliative Care Trigger Status vs Actual Needs Among Critically Ill Patients and Their Family Members. JAMA Netw Open, 5(1), e2144093. https://doi.org/10.1001/jamanetworkopen.2021.44093
Cox, Christopher E., Deepshikha Charan Ashana, Krista L. Haines, David Casarett, Maren K. Olsen, Alice Parish, Yasmin Ali O’Keefe, et al. “Assessment of Clinical Palliative Care Trigger Status vs Actual Needs Among Critically Ill Patients and Their Family Members.JAMA Netw Open 5, no. 1 (January 4, 2022): e2144093. https://doi.org/10.1001/jamanetworkopen.2021.44093.
Cox CE, Ashana DC, Haines KL, Casarett D, Olsen MK, Parish A, et al. Assessment of Clinical Palliative Care Trigger Status vs Actual Needs Among Critically Ill Patients and Their Family Members. JAMA Netw Open. 2022 Jan 4;5(1):e2144093.
Cox, Christopher E., et al. “Assessment of Clinical Palliative Care Trigger Status vs Actual Needs Among Critically Ill Patients and Their Family Members.JAMA Netw Open, vol. 5, no. 1, Jan. 2022, p. e2144093. Pubmed, doi:10.1001/jamanetworkopen.2021.44093.
Cox CE, Ashana DC, Haines KL, Casarett D, Olsen MK, Parish A, O’Keefe YA, Al-Hegelan M, Harrison RW, Naglee C, Katz JN, Frear A, Pratt EH, Gu J, Riley IL, Otis-Green S, Johnson KS, Docherty SL. Assessment of Clinical Palliative Care Trigger Status vs Actual Needs Among Critically Ill Patients and Their Family Members. JAMA Netw Open. 2022 Jan 4;5(1):e2144093.

Published In

JAMA Netw Open

DOI

EISSN

2574-3805

Publication Date

January 4, 2022

Volume

5

Issue

1

Start / End Page

e2144093

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Prospective Studies
  • Predictive Value of Tests
  • Palliative Care
  • North Carolina
  • Needs Assessment
  • Middle Aged
  • Male
  • Intensive Care Units
  • Humans