Equity of care for all patients approaching the end of life regardless of age or diagnosis is a key development in recent years. The Quality and Outcomes Framework for general practice now includes all diagnoses explicitly. The GSF Prognostic Indicators Guidance is held up as an easily accessible document which has moved thinking forward.
As a generalisation 3 broad trajectories of illness can be identified with differing requirements – that of the cancer patient, the organ failure patient (heart failure, COPD etc) and the elderly frail / dementia patient (from Lynn et al in Palliative Care the Solid Facts 2004 WHO Europe). This way of thinking has helped move forward with identifying patients at the end of life as it is not just those in the final steep decline that we need to identify but all who may be in the last year or so of life. For individuals however, it is not always apparent which trajectory is most applicable.
GSF is intended for use with ALL dying patients from each trajectory – all the templates are suitable and there is nothing to exclude non-cancer patients. Over half the GSF practices nationally use the framework for non-cancer patients within 6 months of implementation and many include all dying patients from the start.
The picture is further complicated by the aging population and as people age they are more likely to have multiple co-morbidities. This is important as their assessment and care package is more complex but also multiple co-morbidities are of themselves a poor prognostic indicator.
Prognostic Indicator Guidance Paper
This paper has been developed by the National GSF Centre, after wide consultation with various specialist clinical bodies and National Disease Associations. The aim of this paper is to support clinicians with identifying patients with non-cancer and cancer diagnosis who are in need of supportive and palliative care, and who should be included on the GSF supportive care register.
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