interRAI assessments: opportunities to recognise need for palliative care?

assessment-1024x819

https://onlinelibrary.wiley.com/doi/abs/10.1111/ajag.12840

I had been curious for some time about the potential for interRAI assessments to identify people who might benefit from palliative care interventions such as advance care planning, symptom management and goals of care conversations.

With a global ageing population and people living longer with life limiting illnesses, many countries are experiencing an increasing number of people living with palliative care needs across a range of different care settings. However, we  know that recognising and assessing palliative care need can be difficult. Left unattended, unmet palliative care need can result in significant distress and suffering for patients and their families, unplanned hospital admissions and poor use of limited health and social care resources.

Assessment tools routinely used in practice which integrate aspects of palliative care screening and assessment have the potential to support a more  comprehensive approach to care planning at the end of life.  Such an approach could help meet policy recommendations for equitable and timely palliative care ensuring that people get the right care at the right time, regardless of their diagnosis, care provider or care setting.  Given the frequent use of interRAI assessments in care planning, their potential to identify palliative care need could be great. A widely used suite of assessment tools the international Resident Assessment Instrument (interRAI) assessment tools are typically used to plan care for older people aged over 65 years, however they are increasingly used for anyone living in the community or in a long-term care setting with complex health and functional care needs as well as those with a life limiting illness, regardless of age.

The aim of this study was to explore how the two most commonly used interRAI assessment tools in the last year of life; the Home Care assessment and Long-Term Care Facility assessment tools, could be used to identify opportunities to integrate palliative care into a plan of care.  A population based cross sectional design linking deaths with the NZ national interRAI database was adopted.

A total of 4,869 deaths were identified of which 50.9% (n=2,478) received one or more interRAI assessments in the 12 months prior to death. This study revealed opportunities for the interRAI assessment to identify people who might benefit from a palliative care approach. Missed opportunities to ensure that patient preferences and treatment limitations are documented were evident. In addition, the timing of most assessments occurred very late in the illness suggesting a lack of future care planning.

Future research is needed to understand how interRAI assessors can be supported in the application of questions related to palliative care. Indeed, while there are 27 clinical assessment protocols embedded in the Home Care and Long Term Care Facility assessment tools which are designed to focus the assessor and subsequently inform the care plan, there are currently no protocols which are focused on the need for palliative care.  Work is needed to develop clinical assessment protocols which can be embedded in the Home Care and Long Term Care Facility assessments and are focused on assessment points relevant to palliative care.

Dr Jackie Robinson j.robinson@auckland.ac.nz

Prof. Merryn Gott, Dr Rosemary Frey, Dr Michal Boyd, Heather McLeod, Dr Brigette Meehan

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