A pilot study of the Palliative Care and Rapid Emergency Screening (P-CaRES) tool to screen older emergency department patients for palliative care in Malaysia

The Palliative Care and Rapid Emergency Screening (P-CaRES) tool was developed as a brief screening tool to be used in the emergency department for early identification of patients needing palliative care. This pilot study aimed to evaluate the tool in the Malaysian setting by assessing its feasibility, acceptability, diagnostic accuracy, and prognostic value for 3-month mortality. This was a prospective, observational single-center study involving patients aged 60 and above admitted from the emergency department from June 2024 to April 2025. Emergency clinicians screened patients using the P-CaRES tool, while a palliative care physician-blinded to the screening results-independently assessed whether the patient required palliative care using structured clinical information. Screening feasibility was measured by time-to-completion, and acceptability was assessed using a modified Ottawa Acceptability of Decision Rules Instrument (OADRI). Patients were followed up to determine 3-month mortality. A total of 40 patients were enrolled. Mean screening time was 3.32 (SD ± 1.23) min. The tool had high acceptability with 100% of clinicians agreeing that the tool was useful and would benefit their patients. The P-CaRES screening demonstrated a 33.3% sensitivity, 93.8% specificity, 88.9% positive predictive value (PPV), and 48.4% negative predictive value (NPV). P-CaRES agreement with palliative care opinion was fair (kappa = 0.23). The 3-month mortality was 55.6% for P-CaRES positive and 6.5% P-CaRES negative. These findings suggest that the P-CaRES is a feasible and acceptable tool to identify patients at risk of short-term mortality. However, given its low sensitivity in the study cohort, its role as a screening tool for palliative care referrals may be limited. Further training in palliative care for the cohort, refinement, and validation of the tool are needed to improve its reliability and applicability in the Malaysian context.