Recognise End of Life
Just as there is a period at the beginning of life, there is also a period at the end of life. End of life is when a person is living with, and impaired by, a fatal condition, even if the trajectory is ambiguous or unknown. This period may be years in the case of people with chronic or malignant disease, or very brief in the case of people who suffer acute and unexpected illnesses or events, such as sepsis, stroke or trauma.
More specifically, the Australian Commission on Safety and Quality in Health Care states that: “People are ‘approaching the end-of-life’ when they are likely to die within the next 12 months. This includes people whose death is imminent (expected within a few hours or days) and those with:
- advanced, progressive, incurable conditions,
- general frailty and co-existing conditions that mean they are expected to die within 12 months,
- existing conditions, if they are at risk of dying from a sudden acute crisis in their condition,
- life threatening acute conditions caused by sudden catastrophic events.” 1(p33)
What is End of Life Care?
Care at the end of life is palliative care. In keeping with this definition, end of life care encompasses “the broad set of health and community services that care for the population at the end of their life. Quality end of life care is realised when strong networks exist between specialist palliative care providers, primary generalist providers, primary specialists and support care providers and the community – working together to meet the needs of people requiring care.”2(p36)
General practitioners can assist with coordination across primary, home, and residential aged care settings.
Primary care practitioners need to consider the palliative care needs of all patients with life-limiting illnesses including metastatic cancer, chronic disease, organ failure and degenerative neurological conditions.
Tools and resources are available to support primary care practitioners in identifying patients who may benefit from review of their care needs and palliative care.
The ‘surprise question' - Identification of patients approaching the end of life
Supportive and Palliative Care Indicators Tool (SPICTTM)’, and ‘Guideline to using SPICTTM in the community
The 'surprise question' is used for patients with advance disease or progressive life-limiting conditions, and is completed by asking either yourself or the care team ‘Would you be surprised if the patient were to die in the next few months, weeks, days?’ The answer to this question should be an intuitive one, pulling together a range of clinical, co-morbidity, social and other factors that give a whole picture of deterioration. If you would not be surprised, then what measures might be taken to improve the patient’s quality of life now and in preparation for possible further decline? A palliative approach should be considered for any patient when you would not be surprised if they died within the next twelve months.