Is this patient approaching the end of life?

Determining with certainty if a patient is in their final year of life can be difficult if they are following a frailty or organ failure trajectory¹³. A range of tools exist to help identify people approaching the end of life (such as SPICT – Supportive and Palliative Care Indicators Tool), but they may be cumbersome to use in the ED¹⁴.

Ask yourself: “Would I be surprised if this patient died in the next year?”

If the answer is No, then the patient may be approaching the end of life and you should consider whether a palliative care framework is appropriate. However, this ‘surprise’ question has poor sensitivity and specificity for non-cancer trajectories such as frailty¹⁵. Instead, a range of clinical indicators may be helpful¹⁶:

• Two or more unplanned hospital admissions in the past 6-12 months
• Persistent and recurrent infections
• Weight loss of 5-10% in the past 6 months
• Multiple morbidity in addition to frailty
• Combined frailty and dementia
• Delirium
• Increased frequency of falls
• Rapidly rising frailty score
• Escalating patient, family or service provider distress.