Identifying the right patients
Earlier recognition of people nearing the end of their life leads to earlier planning and better care |
About 1% of the population die each year, yet it is intrinsically difficult to predict or identify which patients may be in the last year or so of life. Of the 20 patient deaths on an average GP list only 5 will be due to cancer. The majority can be predicted. If predicted earlier, some supportive care measures could be introduced that would enable earlier discussion of the patient’s wishes, improve care aligned to their preferences and fewer crises. In short, if we could better identify these patients, we might be more able to provide better care for them as they approach the end of their lives.
The GSF prognostic indicators guidance paper suggests which adult patients with any condition predicted to be in the final 6-12 months of life might be in need of supportive/palliative care. It was developed originally to support primary care teams using the Gold Standards Framework (GSF) and Quality Outcome Framework (QOF) to include more of the appropriate patients on their Palliative/Supportive Care Registers, and thereby to encourage better prediction of possible need and provision of care.
The focus is more on improving prediction of need for support, rather than pure prognostication of time remaining. Though all prognostication is inherently inexact, and as people live longer with more co-morbid conditions, there can be disparity between levels of care provided to patients with different diagnoses. This guidance aims to help achieve equity for patients nearing the end of life, whatever their underlying illness and promote excellence in end of life care.
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