A checklist for identifying patients whose death is imminent will be trialled in seven major Sydney hospitals this year, with the aim of moving them into palliative care and sparing them from futile treatments.
While 75% of Australians want to die at home, only 15% manage to do so, said Dr Magnolia Cardona-Morrell, a University of NSW researcher who led the development of the assessment tool.
Too often hospitals were geared towards aggressive treatment and emergency resuscitation rather than a transition to end-of-life care, she said.
“That’s why we gathered all the information we could about identifying patients in the last few months of their life, and came up with a checklist of 29 factors for doctors to consider to help tell them which patients are likely to die within three months,” Cardona-Morrell said.
“Doctors can then have a conversation with the patient and their family about moving them from active treatment and into palliative care, and it will give doctors much more confidence to start that conversation.”
A paper describing the assessment tool was published on Friday in the journal BMJ Supportive & Palliative Care.
The checklist was developed for terminally ill patients aged 55 and above admitted to hospital emergency departments, and assessed vital signs, cognitive impairment, recent hospitalisations, measures of frailty, and the presence of active disease such as cancer or chronic kidney or liver disease.
Delaying unavoidable death through aggressive and expensive treatments was contributing to escalating healthcare costs, Professor Hal Swerissen, a visiting fellow at thinktank the Grattan Institute, said.
The last year of people’s lives in nursing homes and hospitals cost Australia between $4.5bn and $5bn each year, he said, and the number of people dying would double in the next 25 years.
“We need to be directing more attention towards end-of-life and at-home care.
“And while tools like this are really important, what we also need is for clinicians to take seriously the idea that there comes a point where they need to talk to their patient about the fact that they are dying,” Swerissen said.
“They need to become more comfortable about bringing up that possibility with the patient and their families. We have a lot of work to do to improve quality of dying in Australia.”
Palliative Care Australia is undergoing a major restructure of services which will see a renewed emphasis on raising the issue of dying, and preparing for it, its chief executive, Liz Callaghan, said.
While the organisation had been good at reaching out to policy makers, Callaghan said there was work to do in making the issue of death less taboo in the wider community.
“There’s a real reluctance to talk about death and dying, and perhaps it’s because we have three generations of people living in the community who haven’t lived through world wars, and few have experienced any major disasters,” she said.
“I understand why this checklist has been developed, but these conversations shouldn’t be happening in emergency departments.
“They need to be happening out in the community well before adverse events happen.”
