Recognizing the Dying Patient, When Less Could be More: A Diagnostic Framework for Shared Decision-Making at the End of Life.

BACKGROUND

Recognizing dying patients is crucial to produce outcomes that are satisfactory to patients, their families, and clinicians.

AIM

Earlier discussion of and shared decision-making around dying to improve these outcomes.

DESIGN

In this study, we interviewed 16 senior clinicians to develop summaries of palliative care in 4 key specialties: Cardiology, Vascular Surgery, Emergency General Surgery, and Intensive Care.

SETTING

Oxford University Hospitals.

RESULTS

Based on themes common to our 4 clinical areas, we developed a novel diagnostic framework to support shared palliative decision-making that can be summarized as follows: 1) Is the acute pathology reversible? 2) What is the patient's physiological reserve? 3) What is important to the patient? Will they be fit enough for discharge for a reasonable length of time?

CONCLUSIONS

We believe that education using this framework in the medical school and postgraduate curricula would significantly improve recognition of dying patients. This would serve to stimulate earlier conversations, more shared decision-making, and ultimately better outcomes in palliative care and patient experience.