This guidance is not attempting to answer the question ‘how long have I got?’ but more in answer to the question ‘what can we do?’, and is in response to the common way of thinking ‘Hope for the best but prepare for the worst’.
Three triggers for Supportive/ Palliative Care are suggested - to identify these patients we can use any combination of the following methods:
- The surprise question ‘Would you be surprised if this patient were to die in the next 6-12months’ - an intuitive question integrating co-morbidity, social and other factors. If you would not be surprised, then what measures might be taken to improve their quality of life now and in preparation for the dying stage. The surprise question can be applied to years/months/weeks/days and trigger the appropriate actions. The aim is to enable the right thing to happen at the right time eg if days, then begin a Care Pathway for the Dying. Some clinicians find it easier to ask themselves ‘Would you be surprised if this patient were still alive in 6-12 months?’
- Choice / Need - The patient with advanced disease makes a choice for comfort care only, not ‘curative’ treatment, or is in special need of supportive / palliative care eg refusing renal transplant
- Clinical indicators – General and Specific indicators of advanced disease for each of the three main end of life patient groups - cancer, organ failure, elderly frail/ dementia
Prognostic Indicator Guidance
