Abstract:
BACKGROUND:Population ageing will lead to more deaths with an uncertain trajectory. Identifying patients at risk of dying could facilitate more effective care planning. AIM:To determine whether screening for likely death within 12 months is more effective using screening tools or intuition. DESIGN:Randomised controlled trial of screening tools (Surprise Question plus the Supportive and Palliative Care Indicators Tool for Surprise Question positive patients) to predict those at risk of death at 12 months compared with unguided intuition (clinical trials registry: ACTRN12613000266763). SETTING/PARTICIPANTS:Australian general practice. A total of 30 general practitioners (screening tool = 12, intuition = 18) screened all patients ( n = 4365) aged ≥70 years seen at least once in the last 2 years. RESULTS:There were 142 deaths (screening tool = 3.1%, intuition = 3.3%; p = 0.79). General practitioners identified more at risk of dying using Surprise Question (11.8%) than intuition (5.4%; p = 0.01), but no difference with Surprise Question positive then Supportive and Palliative Care Indicators Tool (5.1%; p = 0.87). Surprise Question positive predicted more deaths (53.2%, intuition = 33.7%; p = 0.001), but Surprise Question positive/Supportive and Palliative Care Indicators Tool predictions were similar (5.1%; p = 0.87 vs intuition). There was no difference in proportions correctly predicted to die (Surprise Question = 1.6%, intuition = 1.1%; p = 0.156 and Surprise Question positive/Supportive and Palliative Care Indicators Tool = 1.1%; p = 0.86 vs intuition). Screening tool had higher sensitivity and lower specificity than intuition, but no difference in positive or negative predictive value. CONCLUSION:Screening tool was better at predicting actual death than intuition, but with a higher false positive rate. Both were similarly effective at screening the whole cohort for death. Screening for possible death is not the best option for initiating end-of-life planning: recognising increased burden of illness might be a better trigger.
journal_name
Palliat Medjournal_title
Palliative medicineauthors
Mitchell GK,Senior HE,Rhee JJ,Ware RS,Young S,Teo PC,Murray S,Boyd K,Clayton JMdoi
10.1177/0269216317698621subject
Has Abstractpub_date
2018-02-01 00:00:00pages
384-394issue
2eissn
0269-2163issn
1477-030Xjournal_volume
32pub_type
杂志文章,随机对照试验abstract:BACKGROUND:Patients approaching death often have a decreasing oral intake, which can be distressing for relatives. Little is known about the relatives' experiences with and perceptions of oral intake at the end of life. AIM:This study aims to contribute to a more thorough understanding of relatives' concerns regarding...
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abstract::The purpose of this study is to analyze French general practitioners' attitudes toward prescribing opiate painkillers for dying patients and compare them with their attitudes toward making frequent home visits. One hundred and fifteen general practitioners indicated the acceptability of prescribing opiates in 48 scena...
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abstract::This paper reviews a number of studies relating to religion and coping with chronic illness, emphasizing those aspects relevant to palliative care. After pointing out that religious and existential needs are common in chronic illness, a critical examination is made of those studies which purport to demonstrate associa...
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abstract:PURPOSE/OBJECTIVE:Patients with cancer or symptoms referable to cancer therapy were offered acupuncture as potential palliation of their symptoms. This paper describes the physical integration of the discipline into the Oncology Clinic, and patient perspectives on its availability and efficacy. PATIENTS AND METHODS:Be...
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abstract:BACKGROUND:Globally, most care for people with life-limiting illnesses is provided by informal caregivers. Identifying characteristics of caregivers that may have unmet needs and negative outcomes can help provide better support to facilitate adjustment. AIM:We compared characteristics, expressed unmet needs and outco...
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abstract:BACKGROUND:As end-of-life (EoL) care expands across Europe and the world, service developments are increasingly studied. The sociocultural context in which such changes take place, however, is often neglected in research. AIM:To explore sociocultural factors in EoL care in Belgium as represented by the literature. DE...
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abstract:BACKGROUND:the right for patients of all diagnoses to be in receipt of palliative care from an early point in the diagnosis of a life-limiting condition is now enshrined in policy in a number of countries and increased emphasis is placed upon the role of generalist palliative care. However, little is known as to how th...
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更新日期:2012-04-01 00:00:00
abstract:OBJECTIVE:A prospective cohort study evaluated the performance and acceptability of the cognitive based Mood Evaluation Questionnaire (MEQ) in assessing depressive symptoms over time in patients with advanced cancer. The structured clinical interview for DSM-III-R (SCID) and the single-item interview screening question...
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abstract:BACKGROUND:Legacy has been invoked as a means for strengthening human attachments, continuing bonds, and ensuring that individuals will be remembered; however, little is known about the spectrum of approaches to, outcomes associated with, and best practices for legacy interventions. AIM:To systematically review resear...
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pub_type: 杂志文章,多中心研究
doi:10.1177/0269216306072764
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