"Complete Lives System" Update: Test created may predict end of life within 30 days will aid insurance providers and death panels greatly

1/24/2015

Refresher course: "Complete Lives System" by Ezekiel Emanuel

'Death test' could predict chance of dying within 30 days

Health experts say a new test will prevent futile and expensive medical treatments which prolong suffering

A death test which predicts if elderly people will die within 30 days could allow them to go home and say goodbye to family members Photo: Alamy

A test to determine if elderly patients will die within 30 days of being admitted to hospital has been developed by doctors to give them the chance to go home or say goodbye to loved ones.

Health experts say the checklist will prevent futile and expensive medical treatments which merely prolong suffering.

The screening test looks at 29 indicators of health, including age, frailty, illness, mental impairment, previous emergency admissions and heart rate and produces a percentage chance of death within one month and 12 weeks.

Researchers say the aim of Critera for Screening and Triaging to Appropriate aLternative care, or CriSTAL for short, is to kick-start frank discussions about end of life care, and minimise the risk of invasive ineffective treatment.

“Delaying unavoidable death contributes to unsustainable and escalating healthcare costs, despite aggressive and expensive interventions,” said lead author Dr Magnolia Cardona-Morrel, a researcher at the University of New South Wales.

“These interventions may not influence patient outcome; often do not improve the patient’s quality of life; may compromise bereavement outcomes for families; and cause frustration for health professionals.”

Earlier this week Professor Sir Mike Richards, the Chief Inspector of Hospitals for the Care Quality Commission, warned that dying patients are receiving wide variations in care because of hospital failure to replace the Liverpool Care Pathway.

The controversial end-of-life plan was scrapped after a review of the regime found that hospital staff wrongly interpreted its guidance for care of the dying, leading to patients being drugged and deprived of fluids in their last weeks of life.

The Health Select Committee is currently examining palliative and end of life care in the wake of the LCP controversy.

However the new test aims to provide a ‘starting point’ for ‘honest communication with patients and families about recognising that dying is part of the life cycle’

Researchers looked at 112 peer-reviewed studies to find out which tests and questions were the best predictors of death.

They claim the test will help doctors and nurses who are often under great pressure from family members and society to prolong the life of patients at all costs.

“While there are accepted policies for de-escalating treatment in terminally ill patients, there are also inherent and societal pressures on medicine to continue utilising technological advances to prolong life even in plainly futile situations,” said Dr Cardona-Morrel.

“Training for nurses and doctors in the use of the screening tool and in approaching patients and families with concrete information about inevitability of death and lack of benefit of further intensive treatment are paramount.”

Most patients end up dying in hospital, even though that is not their stated preference, when asked.

Caroline Abrahams, Charity Director at Age UK, said:“The best time to begin discussing end of life issues and an older person’s wishes, is well in advance, when they are fit and well, but we acknowledge that this isn’t always possible.

“The ability to accurately identify people entering hospital who are nearing the end of their lives ought to help ensure they receive high quality care, appropriate to their needs, so we welcome this development. However, in practice, access to good end of life care services remains extremely variable and discussions with older people and their families about this most difficult of subjects are not always handled sensitively and well.

“So as well as improved analysis and triage of people’s needs, better training and support for medical staff in speaking compassionately with older people and their families about end of life care is also required. “

By giving families and patients some options about the preferred place of death, the test could also help terminally ill elderly people choose to go home, the authors said.

The checklist is yet to be tested but the researchers hope it will eventually be used for all hospital admissions.

The research was published in the BMJ Open publication Supportive & Palliative Care.

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