# Evaluating Palliative Care Needs in Patients with Advanced Non-Malignant Chronic Conditions: An Umbrella Review of Needs Assessment Tools

## TL;DR

This review evaluates 35 tools for assessing palliative care needs in patients with chronic non-cancer conditions, finding few tools that combine general and disease-specific indicators and highlighting the need for better validation.

## Contribution

The study identifies and evaluates palliative care needs assessment tools for non-malignant chronic conditions, highlighting gaps in psychometric evidence and proposing promising tools.

## Key findings

- Only a few of the 35 identified tools integrate both general and disease-specific palliative care indicators.
- NAT: PD-HF, SPICT, and NECPAL are the most promising tools for this patient population.
- Most tools lack strong psychometric evidence, indicating a need for further validation.

## Abstract

What are the main findings?
This umbrella review identified 35 needs assessment tools for patients with advanced non-malignant chronic conditions, with only a limited number integrating both general and disease-specific palliative care indicators.Significant gaps were found in the psychometric evidence of most tools, with NAT: PD-HF, SPICT, and NECPAL emerging as the most promising for this patient population.

This umbrella review identified 35 needs assessment tools for patients with advanced non-malignant chronic conditions, with only a limited number integrating both general and disease-specific palliative care indicators.

Significant gaps were found in the psychometric evidence of most tools, with NAT: PD-HF, SPICT, and NECPAL emerging as the most promising for this patient population.

What are the implications of the main findings?
Early identification of palliative care needs should prioritize tools that predict functional decline and incorporate both general and disease-specific indicators to support timely and targeted interventions.Further research is required to strengthen the psychometric properties and clinical utility of existing tools and to develop more holistic assessment tools covering physical, psychological, social, and spiritual domains.

Early identification of palliative care needs should prioritize tools that predict functional decline and incorporate both general and disease-specific indicators to support timely and targeted interventions.

Further research is required to strengthen the psychometric properties and clinical utility of existing tools and to develop more holistic assessment tools covering physical, psychological, social, and spiritual domains.

Background/Objectives: Patients with advanced non-malignant chronic conditions experience illness burdens and palliative care needs comparable to those of oncology patients, yet palliative care is often introduced late. Identifying individuals with potential palliative care needs is complex, and although multiple tools exist, the most appropriate approach for assessing needs in this population remains unclear. This umbrella review aimed to identify and evaluate tools used to systematically assess palliative care in adults with advanced non-malignant chronic conditions, with a specific focus on their content, structure, and psychometric properties. Methods: An umbrella review of systematic reviews was conducted in accordance with the Joanna Briggs Institute (JBI) guidance. Four electronic databases (Cochrane Library, CINAHL, PubMed, and PsycINFO) were searched from inception to 30 June 2025. Eligible systematic reviews were screened, critically appraised, and synthesized narratively. Results: Seven systematic reviews met the inclusion criteria, collectively identifying 35 unique needs-assessment tools. Five tools (SPICT, GSF-PIG, QUICK GUIDE, NECPAL, and P-CaRes) incorporated both general and disease-specific palliative care indicators. At the same time, four (PC-NAT, SPEED, NAT, and IPOS) addressed needs across physical, psychological, social, and spiritual domains. Psychometric data were available for six tools across three reviews. The original NAT and SPICT demonstrated good reliability; however, the Dutch version of the NAT showed poor validity. SPEED and one unnamed palliative care tool showed good reliability, whereas the Surprise Question demonstrated unclear validity. Italian-SPICT and Israeli-NECPAL exhibited strong content validity. Conclusions: Despite limited evidence, the NAT: PD-HF shows particular promise for identifying palliative care needs in patients with heart failure. Tools such as SPICT and NECPAL are widely used and adapted for advanced non-malignant chronic conditions, but further psychometric evaluation is required. Additional studies are needed to clarify the clinical utility of these tools for broader implementation in assessing palliative care needs.