International palliative care experts’ view on phenomena indicating the last hours and days of life

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Abstract

Providing the highest quality care for dying patients should be a core clinical proficiency and an integral part of comprehensive management, as fundamental as diagnosis and treatment. The aim of this study was to provide expert consensus on phenomena for identification and prediction of the last hours or days of a patient's life. This study is part of the OPCARE9 project, funded by the European Commission's Seventh Framework Programme.

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Most cited references 13

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Prognostic factors in advanced cancer patients: evidence-based clinical recommendations--a study by the Steering Committee of the European Association for Palliative Care.

Marco Maltoni, Augusto Caraceni, Cinzia Brunelli … (2005)

To offer evidence-based clinical recommendations concerning prognosis in advanced cancer patients. A Working Group of the Research Network of the European Association for Palliative Care identified clinically significant topics, reviewed the studies, and assigned the level of evidence. A formal meta-analysis was not feasible because of the heterogeneity of published studies and the lack of minimal standards in reporting results. A systematic electronic literature search within the main available medical literature databases was performed for each of the following four areas identified: clinical prediction of survival (CPS), biologic factors, clinical signs and symptoms and psychosocial variables, and prognostic scores. Only studies on patients with advanced cancer and survival < or = 90 days were included. A total of 38 studies were evaluated. Level A evidence-based recommendations of prognostic correlation could be formulated for CPS (albeit with a series of limitations of which clinicians must be aware) and prognostic scores. Recommendations on the use of other prognostic factors, such as performance status, symptoms associated with cancer anorexia-cachexia syndrome (weight loss, anorexia, dysphagia, and xerostomia), dyspnea, delirium, and some biologic factors (leukocytosis, lymphocytopenia, and C-reactive protein), reached level B. Prognostication of life expectancy is a significant clinical commitment for clinicians involved in oncology and palliative care. More accurate prognostication is feasible and can be achieved by combining clinical experience and evidence from the literature. Using and communicating prognostic information should be part of a multidisciplinary palliative care approach.

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The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients.

S. Inoue, S Chihara, J Tsunoda … (1999)

Although accurate prediction of survival is essential for palliative care, few clinical methods of determining how long a patient is likely to live have been established. To develop a validated scoring system for survival prediction, a retrospective cohort study was performed with a training-testing procedure on two independent series of terminally ill cancer patients. Performance status (PS) and clinical symptoms were assessed prospectively. In the training set (355 assessments on 150 patients) the Palliative Prognostic Index (PPI) was defined by PS, oral intake, edema, dyspnea at rest, and delirium. In the testing sample (233 assessments on 95 patients) the predictive values of this scoring system were examined. In the testing set, patients were classified into three groups: group A (PPI 4.0). Group B survived significantly longer than group C, and group A survived significantly longer than either of the others. Also, when a PPI of more than 6 was adopted as a cut-off point, 3 weeks' survival was predicted with a sensitivity of 80% and a specificity of 85%. When a PPI of more than 4 was used as a cutoff point, 6 weeks' survival was predicted with a sensitivity of 80% and a specificity of 77%. In conclusion, whether patients live longer than 3 or 6 weeks can be acceptably predicted by PPI.

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Applying the Delphi process to palliative care tool development: lessons learned.

Cheryl Nekolaichuk, D Biondo, Robin L Fainsinger … (2008)

The Delphi technique is an effective method for collecting and synthesizing informed opinions on a highly focused task, from a diverse group of experts who have specialized knowledge in an area of interest. This method has been successfully applied to palliative care research but not commonly to palliative care tool development. The Delphi technique has recently been employed in the development of two palliative pain assessment tools: the Edmonton Classification System for Cancer Pain (ECS-CP) and the Alberta Breakthrough Pain Assessment Tool for Research (ABPAT-R). The purpose of this paper is to: (a) report on our experience of using the Delphi technique for gathering validity evidence for the ECS-CP and ABPAT-R; (b) identify challenges in using this technique including sampling, study and survey design, consensus setting and response rates; and (c) suggest approaches that can add to its effectiveness in national and international collaborations in palliative care instrument development and research. Depending on the design, the Delphi technique can facilitate national or international cooperation both asynchronously (e.g., with mail-out or electronic surveys) and synchronously (e.g., with face-to-face meetings or videoconferencing). International input can assure palliative care tools are relevant in diverse clinical settings and practice cultures. The use of the Delphi technique in palliative care tool development may thereby facilitate international collaborations, rapid knowledge transfer, and effective uptake of novel tools across diverse palliative care settings.

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Author and article information

Journal

Title: Supportive Care in Cancer

Abbreviated Title: Support Care Cancer

Publisher: Springer Nature America, Inc

ISSN (Print): 0941-4355

ISSN (Electronic): 1433-7339

Publication date Created: June 2013

Publication date (Electronic): December 15 2012

Publication date (Print): June 2013

Volume: 21

Issue: 6

Pages: 1509-1517

Article

DOI: 10.1007/s00520-012-1677-3

PubMed ID: 23242388

SO-VID: 94758ca6-93ba-4f58-a9b1-67c7cf3f6dca

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International palliative care experts’ view on phenomena indicating the last hours and days of life

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Most cited references 13

Prognostic factors in advanced cancer patients: evidence-based clinical recommendations--a study by the Steering Committee of the European Association for Palliative Care.

The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients.

Applying the Delphi process to palliative care tool development: lessons learned.

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