Chapter 5 104 Our study shows that the SQ is useful for identifying patients with advanced cancer having palliative care needs at the ED. Since ED-initiated palliative care effectively improves the quality of life of patients, all actions at the ED in NS-patients who, in our study, had a median survival of only three months, should be performed in coherence with appropriate end-of-life care.10 In practice, this includes goals-of-care conversations and palliative care needs assessments at the ED (e.g., Screen for Palliative and End-oflife care needs in the ED (SPEED)45 or the shorter 5-SPEED46), consultation of a palliative care consultation team and referral to appropriate care at the place preferred by the patient and family. More knowledge should be obtained about the use of the ’double surprise question‘ at the ED, adding ’Would I be surprised if this patient is still alive after one year?’ after an S-answer. The double surprise question could improve the SQ’s specificity by identifying a third group more associated with frailty and gradual deterioration.47 The effect of the SQ on the quality of care and whether NS-patients have more palliative care needs than S-patients should be studied. CONCLUSION The SQ is useful to screen for patients with advanced cancer having palliative care needs at the ED with a sensitivity of 89% and positive predictive value of 85%. Addition of ECOG performance status 3-4 in NS-patients further differentiates prognosis and urgency of palliative care needs. We recommend using SQ plus ECOG 3-4 at the ED as trigger to start ED-initiated palliative care and goals-of-care conversations to arrange appropriate care according to patient ’s wishes. Acknowledgments The authors would like to thank Leanne Smit, Tobias Wieles, Mathijs Kruizinga, Iris Groeneveld, Lotte van der Stap, and their colleagues at the Centre of Expertise Palliative Care of the Leiden University Medical Centre. Funding Information This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Disclosure Statement No competing financial interests exist.
RkJQdWJsaXNoZXIy MTk4NDMw