Recognise End of Life
What is 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.”2(p33)
More specifically, the Australian Commission on Safety and Quality in Health Care (ACSQHC) state: “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.”2(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.”3(p36)
Residential aged care services can provide the majority of end of life care for residents and their families. In cases where extra support is needed referral to a specialist palliative care service may be required. We cover this in more detail in the section on working together.
ELDAC Toolkit Educational Video
Watch the ELDAC Recognise End of Life educational video will help you to define end of life; recognise the common signs of end of life and understand the use of end of life tools, such as SPICTTM and Surprise Question.
Recognising a resident’s end of life provides opportunity for assessment of palliative care needs and palliative care planning. There is no one tool that identifies when a resident is approaching this time. The surprise question is suggested as one trigger. So ask yourself of a specific resident ‘Would you be surprised if this resident would die in the next 12 months?’ However, accuracy of this question is relatively low for people without a cancer diagnosis.4
Supportive and Palliative Care Indicators Tools (SPICTTM)
The Supportive and Palliative Care Indicators Tool (SPICTTM) has increased in popularity and is often used in addition to the surprise question. The SPICTTM tool has two sections– General Indicators and Clinical Indicators. To identify that someone may need end of life care, you would have a positive response to one of the six general indicators and one of the clinical indicators.
Another version is available called the SPICT-4ALLTM, which has easy to understand language and is designed to be used by everyone – people with long term illnesses, family and healthcare staff. The SPICT-4ALLTM makes it easier to identify and discuss the signs that a person’s overall health may be declining in order that they receive the care they need in a timely manner.
The SPICTTM tool and the user guidelines are free to download, but the developers of the tool ask that you provide your details prior to download so they can keep you informed of SPICTTM updates and relevant SPICT news.
Remembering end of life care may also be required for a resident that has an acute deterioration. There is more information about this in the Responding to Deterioration section of this toolkit.