Palliative profile, one-year mortality and quality of life in older inpatients according to Be-PICT: a multicenter prospective cohort study

ABSTRACT

Background

A palliative care approach (PCA), including advanced care planning (ACP), should be considered for patients with limited life expectancy. The Belgian Palliative Care Indicators Tool (Be-PICT) has been released to help identify patients who may benefit from such approach. This study aimed at measuring 1-year mortality and describe the quality of life in older inpatients, according to baseline Be-PICT results.

Methods

Prospective multicentre cohort study in older patients (≥ 75 years) admitted at geriatrics and cardiology wards of four Belgian hospitals. The palliative profile was defined as a positive Be-PICT.1, defined by the presence of its three criteria, i.e. a negative physician’s answer to the surprise question ‘would you be surprised if this patient dies in the 6–12 next months?’, ≥ 1 poor health indicator and ≥ 1 life-limiting condition.

Results

Of the 379 patients (50% aged ≥85 years; 51% female), 52 (14%) presented a palliative profile and 83 (23%) died within 1 year. Be-PICT.1 showed the following characteristics to predict 1-year mortality: sensitivity 0.54, specificity 0.83, positive and negative predictive values 0.48 and 0.86, positive and negative likelihood ratios 3.22 and 0.55. The patients with a palliative profile were at higher mortality risk (hazard ratio 4.79 p < 0.001) and 1-year mortality rate (45%). Not using the SQ allowed to improve sensitivity to include a larger number of patients who may benefit from ACP and PCA.

Conclusions

Be-PICT.1 is a simple case-finding tool to identify older inpatients being at high mortality risk and candidates for ACP and PCA.

KEYWORDS:

• Prognosis
• 1-year mortality
• older person
• advance care planning
• palliative care

Acknowledgments

The authors thank Maes H, De Bock R, Van de Vyver C, Duyver E, Cornil C, de la Kethulle de Ryhove C and Badin H for the data collection and data entry, and Guedes A for making recruitment possible. They also thank Professor Boland B. for all his advices and comments.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Contributor

The authors confirm that they have participated sufficiently in the work to take public responsibility for appropriate portions of the content and the manuscript has been read and approved by all the named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. The order of authors listed in the manuscript has been approved by all the authors. RP and NVDN conceived and designed the study; IDB SH, HB and MDS-H were involved in recruitment and data collection; SH and IDB performed the data analysis; IDB drafted the manuscript; IDB, SH, HB, NVDN, MDS-H and RP helped in critical revision for important intellectual content; all authors were involved in final approval of the version to be published.

Ethics approval and consent to participate

This study was approved by the medical ethics committee with Belgian registration number B670201734351.

Additional information

Funding

This work was supported by the Fund Marie-Thérèse De Lava, King Baudouin Foundation, Belgium.