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Original research
NECPAL tool prognostication in advanced chronic illness: a rapid review and expert consensus
  1. Xavier Gómez-Batiste1,2,
  2. Pamela Turrillas1,2,
  3. Cristian Tebé3,
  4. Agnès Calsina-Berna1,2 and
  5. Jordi Amblàs-Novellas2,4
  1. 1 The 'Qualy' Observatory/WHO Collaborating Centre for Public Health Palliative Care Programmes, Institut Catala d' Oncologia, Barcelona, Spain
  2. 2 Chair of Palliative Care, Faculty of Medicine, University of Vic ‒ Central University of Catalonia, Vic, Barcelona, Spain
  3. 3 Department of Statistics, Biomedical Research Institute of Bellvitge (IDIBELL), Barcelona, Spain
  4. 4 Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic – Central University of Catalonia, Vic, Barcelona, Spain
  1. Correspondence to Professor Xavier Gómez-Batiste, The 'Qualy' Observatory/WHO Collaborating Centre for Public Health Palliative Care Programmes, Institut Catala d' Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; xgomez{at}iconcologia.net

Abstract

Objective To develop a proposal for a 2-year mortality prognostic approach for patients with advanced chronic conditions based on the palliative care need (PCN) items of the NECesidades PALiativas (NECPAL) CCOMS-ICO V.3.1 2017 tool.

Methods A phase 1 study using three components based on the NECPAL items: (1) a rapid review of systematic reviews (SRs) on prognostic factors of mortality in patients with advanced chronic diseases and PCNs; (2) a clinician and statistician experts' consensus based on the Delphi technique on the selection of mortality prognostic factors; and (3) a panel meeting to discuss the findings of components (1) and (2).

Results Twenty SRs were included in a rapid review, and 50% were considered of moderate quality. Despite methodological issues, nutritional and functional decline, severe and refractory dyspnoea, multimorbidity, use of resources and specific disease indicators were found to be potentially prognostic variables for mortality across four clinical groups and end-of-life (EoL) trajectories: cancer, dementia and neurologic diseases, chronic organ failure and frailty. Experts’ consensus added ‘needs’ identified by health professionals. However, clinicians were less able to discriminate which NECPAL items were more reliable for a ‘general’ model. A retrospective cohort study was designed to evaluate this proposal in phase 2.

Conclusions We identified several parameters with prognostic value and linked them to the tool’s utility to timely identify PCNs of patients with advanced chronic conditions in all settings of care. Initial results show this is a clinical and feasible tool, that will help with clinical pragmatic decision-making and to define services.

  • prognosis
  • chronic conditions

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/bmjspcare-2019-002126

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors XGB and PT conceptualised and designed the study. PT was involved in data collection, performed the rapid review of systematic reviews and qualitative analysis of the experts’ consensus and panel meeting. CT performed the statistical analysis. PT, XGB, JAN and CL contributed to data analysis and interpretation of the findings. PT, XGB and CT wrote the draft of the manuscript. PT, XGB, JAN, CT and CL reviewed and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.