Earlier recognition that a person may be approaching the end of their life provides both clinicians and patients and their families opportunities to establish their goals of care and to plan for their changing care demands into their future. This also allows for earlier consideration of approaches to care that focus on improved quality of life. Improved satisfaction with care, quality of life, physical and psychological symptoms and health service utilisation are all documented benefits of this approach to care (El-Jawahri et al, 2011; van der Steen et al, 2014; Temel et al, 2010; Zimmerman et al, 2014).
Earlier recognition also increases capacity to improve support to carers and families, especially where the patient’s goals of care include remaining at home.
Through four clinical perspectives this forum explored how identifying when someone may be in the last year of life is an essential element of good patient care. Presenters also discussed some of their local challenges, barriers and ways forward.
The ACI Palliative Care Network commissioned an evidence check to identify and review tools to aid clinical identification of end of life. The evidence check sought to identify populations and settings in which clinical assessment tools could be used; barriers and enablers to their implementation and to develop a better understanding of the relevant and potential applicability of the tools in the NSW context.
Disclaimer: This evidence check has identified a growing body of work supporting the development of tools to aid clinical identification of end of life. It is important to acknowledge that prognostication is an inexact science, and the tools identified are clinical aids rather than the answer to the question of specific prognostic accuracy.