title: Early identification of palliative care patients in general practice: development of RADboud indicators for PAlliative Care Needs (RADPAC).
abstract: BACKGROUND
  According to the World Health Organization (WHO) definition, palliative care should be initiated in an early phase and not be restricted to terminal care. In the literature, no validated tools predicting the optimal timing for initiating palliative care have been  determined.
  
  
  OBJECTIVE
  The aim of this study was to systematically develop a tool for GPs with which they can identify patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and cancer respectively, who could benefit from proactive palliative  care.
  
  
  METHODS
  A three-step procedure, including a literature review, focus group interviews with input from the multidisciplinary field of palliative healthcare professionals, and a modified Rand Delphi process with GPs.
  
  
  METHODS
  The three-step procedure  was used to develop sets of indicators for the early identification of CHF, COPD, and cancer patients who could benefit from palliative care.
  
  
  RESULTS
  Three comprehensive sets of indicators were developed to support GPs in identifying patients with CHF, COPD, and cancer  in need of palliative care. For CHF, seven indicators were found: for example, frequent hospital admissions. For COPD, six indicators were found: such as, Karnofsky score ≤50%. For cancer, eight indicators were found: for example, worse prognosis of the primary tumour.
  
  
  CONCLUSIONS
  The RADboud indicators for PAlliative Care Needs (RADPAC) is the first tool developed from a combination of scientific evidence and practice experience that can help GPs in the identification of patients with CHF, COPD, or cancer, in need of palliative care. Applying the RADPAC facilitates  the start of proactive palliative care and aims to improve the quality of palliative care in general practice.
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. b.thoonsen@anes.umcn.nl
authors.forename: Bregje
authors.initials: B
authors.lastname: Thoonsen
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Engels
authors.forename: Eric
authors.initials: E
authors.lastname: van Rijswijk
authors.forename: Stans
authors.initials: S
authors.lastname: Verhagen
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
authors.forename: Marieke
authors.initials: M
authors.lastname: Groot
authors.forename: Kris
authors.initials: K
authors.lastname: Vissers
mesh_terms: D000328:Adult; D000368:Aged; D017144:Focus Groups; D058006:General Practice / Q000379:methods*; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D017567:Karnofsky Performance Status; D008875:Middle Aged; D020380:Needs Assessment; D009369:Neoplasms / Q000628:therapy*; D009426:Netherlands; D010166:Palliative Care; D018579:Patient Selection; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D055815:Young Adult