果冻影院

The findings, published in BMJ Open, builds on the team鈥檚 research finding last year that some doctors are frequently inaccurate when predicting how long those living with terminal illnesses will survive. The previous study revealed a wide variation in errors, ranging from an underestimate of 86 days to an overestimate of 93 days.

鈥淏eing able to accurately predict when a patient is likely to die is important as it lets patients and their families prepare for the death, and it enables health professionals to make sound decisions about palliative care. After discovering that many clinicians鈥� predictions are not accurate enough, we wanted to understand how to improve these predictions, to inform clinical practice,鈥� said the study鈥檚 lead author Dr Nicola White (Marie Curie Palliative Care Research Department at 果冻影院).

The NICE guideline 鈥楥are of dying adults in the last days of life鈥� describes the recognition of imminent death as an essential first step towards improving care for dying patients. However, it does not clearly explain how clinicians are expected to identify such patients or offer advice about less experienced doctors can learn or improve their clinical skills in this area.

The team鈥檚 new study set out to, first, identify a group of palliative care doctors who had particular expertise at recognising when a patient is dying. Those doctors volunteered to complete an online test, in which they were presented with 20 real case studies of patients who had been referred to a hospital or hospice for palliative care. The doctors were asked to decide whether the patient was close to death or not, and the results enabled researchers to identify the top 20% of participants who were most accurate at predicting when the patients would die.

The 鈥榯op performers鈥� were then presented with an additional 50 cases of hypothetical patients and were again asked to estimate the probability of death within the next 72 hours. Based on the decision-making of this expert group, the researchers were able to determine the relative importance of different factors that unconsciously lay behind the doctors鈥� survival predictions.

The most influential factor was the Palliative Performance Score, which measures how much support someone needs based on their functional ability: ranging from fully independent (100%) to bed bound, needing full support and unconsciousness (10% and below). The next most important factor was the presence of an abnormal breathing pattern called Cheyne Stoke breathing. 听

鈥淓ven at the very end of their lives, patients, their families and the staff looking after them want to know how long they may have left to live,鈥� said senior author Professor Paddy Stone (Marie Curie Palliative Care Research Department at 果冻影院).

鈥淭his research has shone a light on how expert doctors are able to recognise when terminally ill patients are nearing the ends of their lives and it is to be hoped that this greater understanding will help to educate medical students and less experienced doctors about how to improve this clinical skill,鈥� he added.

鈥淲hen someone is unwell and imminently dying, the question that is almost always asked is 鈥榟ow long has my loved one got?鈥� This is such an important issue since it allows people to make the very best decisions. This paper reinforces that expertise and knowledge in this area is needed; we need to understand how we can help people to manage the uncertainties that can occur at this time,鈥� said co-author Dr Adrian Tookman, Medical Director at the Marie Curie Hospice, Hampstead.

The researchers hope the study will help inform the development of educational training materials to teach doctors, medical students and other healthcare professionals how to model their own judgement policies on those of the experts.

The study was supported by the terminal illness charity Marie Curie and a 果冻影院 PhD studentship.

Links

• Marie Curie Palliative Care Research Department at 果冻影院
• 果冻影院 Psychiatry

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