Chapter 1 20 palliative care needs. Most of these tools are tested in patients with cancer, but there are also tools for patients with heart failure, chronic obstructive pulmonary disease, and frailty. There are adjusted versions for various healthcare settings as well. Screening tools identifying patients with palliative care needs are the Supportive and Palliative Care Indicators Tool (SPICT), Necesidades Paliativas (NECPAL) identification tool, Golden Standards Framework—Proactive Identification Guidance (GSF-PIG), Radboud indicators for Palliative Care Needs (RADPAC), and a Centre to Advance Palliative Care’s checklist.49, 50, 79-81 A recent systematic review on palliative care needs screening tools in primary care also included the Palliative care: Learning to Identify in people with intellectual disabilities (PALLI) and the ‘Rainoe tool’.82 In the Netherlands, the SPICT and RADPAC are most frequently used, which both combine the surprise question, trigger moments and clinical indicators.2 In a more recent version of the SPICT, the surprise question was removed because studies showed its test performance was limited in patients with diseases other than cancer.77, 78 4. A SSESSMENT OF PALLIATIVE CARE NEEDS OF PATIENTS AND THEIR FAMILY After identification of patients and family with palliative care needs, discussions about their wishes regarding the last phase of life, and comprehensive assessments of the physical, psychological, social, and spiritual dimensions should take place across the illness trajectory.2, 83 This section demonstrates the assessment of palliative care needs and information needs (4.1), and the importance of early discussion of the end-of-life preferences of patients and their family (4.2). 4.1 Assessment of palliative care needs Assessment of patient-reported symptoms in palliative care is beneficial since it improves quality of life, reduces emergency department admissions, and may even improve oneyear survival, as is shown in Basch et al.’s randomized controlled trial in 766 patients with advanced cancer.84 Many tools have been developed to structure assessments of problems and symptoms in the four dimensions of palliative care: the physical, psychologic, social and existential.83, 85, 86 Most multidimensional assessment tools are developed for assessments in patients with cancer.86 The following paragraph focusses on the tools that are used most frequently in the Netherlands. In 2018, IKNL published a selection of measurement instruments in palliative care that are validated in Dutch and validated for use in palliative care.2, 87 These instruments are of multidimensional nature:
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