title: Identification of hospital patients in need of palliative care--a predictive score.
abstract: BACKGROUND
  Palliative care was initially developed for patients with advanced cancer. Over the past years, however, palliative care has broadened its focus from terminal cancer patients to patients with other serious, life-limiting illnesses. Nevertheless, the identification of palliative care needs (PCNs) among hospital patients remains an insufficiently investigated topic of research. The aim of our study was to describe the characteristics of hospital patients with palliative care needs and to develop a score for their identification.
  
  
  METHODS
  We conducted an epidemiological study. Data were collected prospectively from inpatients at the University Medical Center Freiburg, Germany. For each patient discharged from a hospital ward, the treating physician had to report whether the patient had PCNs or not. The response rate was 96%, and data from 39,849 patients could be analyzed. A binary logistic regression analysis was performed in order to identify risk factors for developing PCNs and to develop a predictive score for the identification of patients with PCNs upon their admission to the hospital. In order to validate the risk prediction model, we used a bootstrap analysis.
  
  
  RESULTS
  During the study period, 6.9% (2757) of all patients had palliative care needs. Only 56 of them (2%) received palliative treatment. Binary logistic regression analysis showed that older patients without relatives who suffered from metastatic cancer and/or liver cirrhosis had the highest risk of developing palliative care needs (PCN-score; sensitivity: 0.815; specificity: 0.640).
  
  
  CONCLUSIONS
  Given the aging population and associated increase in the number of patients requiring palliative care, it is crucial to detect palliative care needs in hospital patients with both cancerous and non-cancerous life-limiting diseases. Our predictive score contributes to the identification of palliative care needs in patients with life-limiting diseases, which allows physicians to take the appropriate therapeutic steps.
authors.affiliation: Clinic for Palliative Care, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany. cornelia.meffert@uniklinik-freiburg.de.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Meffert
authors.affiliation: Institute for Medical Biometry and Statistics, Medical Center - University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany.
authors.forename: Gerta
authors.initials: G
authors.lastname: Rücker
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Therapy, St. Vincent Hospital Landau, Cornichonstr. 4, 76829, Landau, Germany.
authors.forename: Isaak
authors.initials: I
authors.lastname: Hatami
authors.affiliation: Clinic for Palliative Care, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany.
authors.forename: Gerhild
authors.initials: G
authors.lastname: Becker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany; D006801:Humans; D007297:Inpatients / Q000145:classification*; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010166:Palliative Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000145:classification*; D019452:Terminally Ill