Is this patient approaching the end of life?

Determining with certainty if a patient is in their final year of life can be difficult if they are following a frailty or organ failure trajectory¹³. A range of tools exist to help identify people approaching the end of life (such as SPICT Supportive and Palliative Care Indicators Tool), but they may be cumbersome to use in the ED¹⁴.

Ask yourself: Would I be surprised if this patient died in the next year?

If the answer is No, then the patient may be approaching the end of life and you should consider whether a palliative care framework is appropriate. However, this surprise question has poor sensitivity and specificity for non-cancer trajectories such as frailty¹⁵. Instead, a range of clinical indicators may be helpful¹⁶:

• Two or more unplanned hospital admissions in the past 6-12 months
• Persistent and recurrent infections
• Weight loss of 5-10% in the past 6 months
• Multiple morbidity in addition to frailty
• Combined frailty and dementia
• Delirium
• Increased frequency of falls
• Rapidly rising frailty score
• Escalating patient, family or service provider distress.