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.