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Original research
Supportive and Palliative Care Indicators Tool prognostic value in older hospitalised patients: a prospective multicentre study
  1. Ruth Piers1,2,
  2. Isabelle De Brauwer3,4,
  3. Hilde Baeyens5,
  4. Anja Velghe1,2,
  5. Lineke Hens6,
  6. Ellen Deschepper7,
  7. Séverine Henrard4,8,
  8. Michel De Pauw2,6,
  9. Nele Van Den Noortgate1,2 and
  10. Marie De Saint-Hubert9
  1. 1Department of Geriatric Medicine, University Hospital Ghent, Ghent, Belgium
  2. 2Department of Internal Medicine and Pediatrics, Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
  3. 3Department of Geriatric Medicine, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
  4. 4UCL Institute of Health and Society, Bruxelles, Belgium
  5. 5Department of Geriatric Medicine, AZ Alma campus Eeklo, Eeklo, Belgium
  6. 6Department of Cardiology, University Hospital Ghent, Ghent, Belgium
  7. 7Biostatistics Unit, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
  8. 8UCLouvain Louvain Drug Research Institute, Bruxelles, Belgium
  9. 9Department of Geriatric Medicine, CHU UCL Namur, Yvoir, Namur, Belgium
  1. Correspondence to Prof Ruth Piers, Department of Geriatric Medicine, University Hospital Ghent, Gent, Oost-Vlaanderen, Belgium; ruth.piers{at}uzgent.be

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.

  • prognosis
  • clinical decisions
  • clinical assessment
  • end of life care
  • hospital care
  • heart failure

Data availability statement

Data are available upon reasonable request. All data relevant to the study can be attained through reasonable request from the principal investigator (ruth.piers@ugent.be).

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjspcare-2021-003042

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    Data availability statement

    Data are available upon reasonable request. All data relevant to the study can be attained through reasonable request from the principal investigator (ruth.piers@ugent.be).

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    Footnotes

    • Contributors The authors confirm that they have participated sufficiently in the work to take public responsibility for appropriate portions of the content and the manuscript has been read and approved by all the named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. The order of authors listed in the manuscript has been approved by all the authors. RP and NVDN conceived and designed the study; RP, IDB, AV, HB, LH MDP and MDS-H were involved in recruitment and data collection; RP, ED and SH performed the data analysis; RP drafted the manuscript; IDB, AV, HB, AV, LH, ED, SH, MDP, NVDN and MDS-H helped in critical revision for important intellectual content; all authors were involved in final approval of the version to be published.

    • Funding This work was supported by Fund Marie-Thérèse De Lava, King Baudouin Foundation, Belgium (to RP).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.