PalliScore: Validation of a rapid scoring system for enhancing decision-making in the Emergency Department for cancer patients in palliative care

BackgroundThe increasing presence of cancer patients in palliative care within emergency departments (ED) worldwide calls for improved care quality. These patients often undergo unnecessary invasive procedures due to challenges in promptly assessing their treatment needs. We developed PalliScore, a rapid assessment tool aimed at helping medical professionals quickly identify palliative care patients in the ED who are less likely to benefit from invasive procedures or ICU admission.MethodsWe retrospectively analyzed data from cancer patients in palliative care admitted to the ED of our hospital in Southeast Brazil, calculating their PalliScore upon admission. This four-step tool incorporates diagnosis of an incurable and life-threatening disease, special care situations (e.g., family or medical team disagreements, uncontrolled symptoms), the “surprise question� (Would you be surprised if this patient died within the next 12 months?), and performance status (ECOG or PPS). Each criterion is scored to reflect the PalliScore, with a threshold of ≥5 suggesting a need to consider limiting invasive interventions after thorough discussion with the patient and healthcare providers.ResultsFrom March 2021 to July 2023, we assessed 521 patients; 70 (13.68%) received limited intervention care while 449 received intensive care. The average PalliScore was 6.50 for the limited care group and 2.77 for the intensive care group. Statistical analysis using an unpaired t-test showed a significant difference in PalliScore between the groups (odds ratio 3.73, p < 0.0001). Notably, 16.7% of patients with a PalliScore ≥ 5 still received intensive care treatments, whereas 10% of patients with a PalliScore < 5 received limited intervention care.ConclusionsPalliScore effectively aids ED physicians in making informed decisions regarding invasive procedures and ICU admissions, thereby potentially improving the quality of care for cancer patients in palliative settings. This tool highlights the complex nature of decision-making in palliative care, emphasizing the need for sensitive and individualized patient assessments.Legal entity responsible for the studyThe authors.FundingHas not received any funding.DisclosureAll authors have declared no conflicts of interest.