Recognising the need for palliative care

RUN-PC Tool

• An evidence-based tool to aid in the prioritisation of patient referral to specialist palliative care services.
• For inpatient unit setting, hospital consultation setting, or community setting.
• An online calculator for rapid assessment based on 7 items across physical, psychosocial and caregiver domains.
• A pdf of outcomes can be printed or saved.
• Takes approximately 5 minutes to complete.

SPEED

• Screen for Palliative and End-of-life care needs in the Emergency Department.
• For patients with cancer.
• Symptom assessment tool which covers: social, therapeutic, physical, psychological and spiritual
• 13 questions.

The Surprise Question (367kb pdf)

• Can aid in the identification of patients changing needs.
• For patients with advanced disease of progressive life limiting conditions.
• One question.

Supportive & Palliative Care Indicators Tool (SPICT) 

• Helps clinicians identify people with one or more general indicators of poor or deteriorating health and clinical signs of life-limiting conditions for assessment and care planning.
• Provides indictors which clinicians can use to identify when it may be appropriate to initiate end-of-life care discussions with patients and their families or carers, as well as substitute decision makers.
• Has 6 general indicators of deteriorating health and increasing care needs, including trigger events.
• Outlines 6 core aspects of palliative care and future care planning.
• Takes approximately 5 – 9 minutes to complete.
• CareSearch interactive versions of the SPICT (315kb pdf) and SPICT4ALL (317kb pdf) forms for online use.

NAT-PD (128kb pf)

• Needs Assessment Tool: Progressive Disease. In generalist settings (e.g. general practice, oncology and cardiology) it can be used to determine which needs may be met in that setting and which needs are more complex and may be better managed by specialists.
• One page assessment tool that can be completed by health professionals across a range of disciplines.
• 73 questions.

Gold Standards Framework - Proactive Identification Guidance (PIG) – 7^th edition.

• This stepped framework helps clinicians to identify patients early, based on general and condition specific indicators, assess needs and wishes, and to plan care tailored to the patients’ choices.
• Uses 3 triggers to identify patients nearing end of life: Includes the Surprise Question (Would you be surprised if this patient were to die in the next few months, weeks, days?); general indicators of decline; and specific clinical indicators related to certain conditions.
• Predicting needs rather than an exact prognostication.

Australian-modified Karnofsky Performance Scale (AKPS)

Physical performance state also has prognostic significance, especially in advanced cancer. The Australian-modified Karnofsky Performance Scale (AKPS) is a measure of a patient’s overall ability to undertake activities of daily living.

• A single score between 10 and 100 is assigned by a clinician, based on observing a patient’s ability to perform everyday activity, work and self-care tasks.
• A score of less than 40 correlates to a median survival of around 3 months for patients with advanced cancer.

The signs that a person may be entering the terminal phase include:

• Deteriorating day by day or hour by hour
• Becoming bed-bound for most of the day
• Extreme tiredness and weakness
• Sleepiness and drowsiness
• Being less responsive and less able to communicate
• Needing help with all personal care
• Little interest in food or drink
• Difficulty swallowing food, fluids and oral medication
• Reduced urine output
• New urinary or faecal incontinence
• Changes in their normal breathing pattern
• Noisy chest secretions
• Mottled skin and cold skin particularly hands and feet
• Delirium
• The person telling you they may feel like they are dying

Visit End-of-Life Essentials, Recognising the End-of-Life module.

Take the End-of-Life Essentials module

Knowing whether a person is entering the last days of life or stabilising or if there is potential for even temporary improvement can be difficult, as signs might be inconsistent or fluctuating.

Useful Tools include:

Use the End-of-life Essentials toolkit action checklist to guide recognising the end-of-life.

CriSTAL

• Criteria for screening and triaging appropriate end-of-life care.
• For older terminal / dying patients on admission to estimate their risk of death in the short term and facilitate discussions on care preferences (hospitalisations or community care).
• 29 items including physical and clinical measures, hospital admissions, patient history of disease.

End-of-Life Essentials Action Toolkit (456kb pdf)

Access the Toolkit