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Background <p>The increasing prevalence of chronic diseases makes identifying patients in need of palliative care essential for public health systems. Several tools have been developed to identify patients with palliative care needs and limited life expectancy. This study aimed to evaluate the performance of the NECPAL and PaP tools in patients with advanced chronic diseases and to explore their potential role in identifying palliative care needs and prognostic assessment.</p> Methods <p>Prospective, observational, multicenter study using the Necesidades Paliativas tool (NECPAL CCOMS-ICO version 1.0), Palliative Prognostic score (PaP score), and functional and symptom assessment tools (Palliative Performance Scale and Edmonton Symptom Assessment System), assessed monthly or every two months for up to 12 months.</p> <p><?noindent??>Information on healthcare utilization and end-of-life care was also collected. Sensitivity, specificity, positive/negative predictive value and accuracy were calculated. The study included three groups of patients with advanced chronic diseases: cancer, pulmonary diseases, and renal diseases. The study was reported following the STROBE guidelines.</p> Results <p>One hundred and ninety-three patients were enrolled: 102 with advanced cancer, 50 with chronic respiratory failure, and 41 with chronic renal failure. The median age was 75 years and 63.7% were male. The overall survival rate was 90% at 30 days and 65% at 12 months. At 30 days, sensitivity and specificity were 100% and 88% for the PaP score, and 89% and 39% for NECPAL. At 12 months, sensitivity and specificity were 20% and 89% for the PaP score, and 88% and 41% for NECPAL. Prognostic accuracy was higher for the PaP score at 30 days (91%) and higher for the NECPAL tool at 12 months (81%). Patients with cancer had more frequent hospitalizations in acute units, while the people living with pulmonary disease had more total hospitalization days.</p> Conclusions <p>The findings suggest that the two instruments may provide complementary information, although the potential benefit of a combined strategy was not directly evaluated in this study.</p>

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Identification of palliative care needs and prognostic factors of survival for tailoring appropriate interventions in advanced oncological, renal, and pulmonary diseases: results from a prospective observational study in an Italian population

  • 期刊论文

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  • 发表日期：

    2026年8月5日

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  • Emanuela Scarpi,
  • Vanessa Valenti,
  • Monia Dall’Agata,
  • Ilaria Bassi,
  • Lucia Angelini,
  • Andrea Carlini,
  • Paola Cravero,
  • Angelo Delmonte,
  • Gaetano La Manna,
  • Giacomo Magnoni,
  • Martina Marchello,
  • Giovanni Mosconi,
  • Oriana Nanni,
  • Stefano Nava,
  • Margherita Currà,
  • Maria Caterina Pallotti,
  • Ilario Giovanni Rapposelli,
  • Marianna Ricci,
  • Anna Scrivo,
  • Alessandra Spazzoli,
  • Danila Valenti,
  • Loretta Zambianchi,
  • Augusto Caraceni,
  • Marco Maltoni,
  • Romina Rossi

摘要

Background

The increasing prevalence of chronic diseases makes identifying patients in need of palliative care essential for public health systems. Several tools have been developed to identify patients with palliative care needs and limited life expectancy. This study aimed to evaluate the performance of the NECPAL and PaP tools in patients with advanced chronic diseases and to explore their potential role in identifying palliative care needs and prognostic assessment.

Methods

Prospective, observational, multicenter study using the Necesidades Paliativas tool (NECPAL CCOMS-ICO version 1.0), Palliative Prognostic score (PaP score), and functional and symptom assessment tools (Palliative Performance Scale and Edmonton Symptom Assessment System), assessed monthly or every two months for up to 12 months.

Information on healthcare utilization and end-of-life care was also collected. Sensitivity, specificity, positive/negative predictive value and accuracy were calculated. The study included three groups of patients with advanced chronic diseases: cancer, pulmonary diseases, and renal diseases. The study was reported following the STROBE guidelines.

Results

One hundred and ninety-three patients were enrolled: 102 with advanced cancer, 50 with chronic respiratory failure, and 41 with chronic renal failure. The median age was 75 years and 63.7% were male. The overall survival rate was 90% at 30 days and 65% at 12 months. At 30 days, sensitivity and specificity were 100% and 88% for the PaP score, and 89% and 39% for NECPAL. At 12 months, sensitivity and specificity were 20% and 89% for the PaP score, and 88% and 41% for NECPAL. Prognostic accuracy was higher for the PaP score at 30 days (91%) and higher for the NECPAL tool at 12 months (81%). Patients with cancer had more frequent hospitalizations in acute units, while the people living with pulmonary disease had more total hospitalization days.

Conclusions

The findings suggest that the two instruments may provide complementary information, although the potential benefit of a combined strategy was not directly evaluated in this study.