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The (un)availability of prognostic information in the last days of life: a prospective observational study

White, N; Reid, F; Harries, P; Harris, AJL; Minton, O; McGowan, C; Lodge, P; ... Stone, P; + view all (2019) The (un)availability of prognostic information in the last days of life: a prospective observational study. BMJ Open , 9 (7) , Article e030736. 10.1136/bmjopen-2019-030736. Green open access

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Abstract

Objectives The aims of this study were (1) to document the clinical condition of patients considered to be in the last 2weeks of life and (2) to compare patients who did or did not survive for 72 hours. Design A prospective observational study. Setting Two sites in London, UK (a hospice and a hospital palliative care team). Participants Any inpatient, over 18 years old, English speaking, who was identified by the palliative care team as at risk of dying within the next 2weeks was eligible. Outcome measures Prognostic signs and symptoms were documented at a one off assessment and patients were followed up 7 days later to determine whether or not they had died. Results Fifty participants were recruited and 24/50 (48%) died within 72 hours of assessment. The most prevalent prognostic features observed were a decrease in oral food intake (60%) and a rapid decline of the participant’s global health status (56%). Participants who died within 72 hours had a lower level of consciousness and had more care needs than those who lived longer. A large portion of data was unavailable, particularly that relating to the psychological and spiritual well-being of the patient, due to the decreased consciousness of the patient. Conclusions The prevalence of prognostic signs and symptoms in the final days of life has been documented between those predicted to die and those who did not. How doctors make decisions with missing information is an area for future research, in addition to understanding the best way to use the available information to make more accurate predictions.

Type: Article
Title: The (un)availability of prognostic information in the last days of life: a prospective observational study
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/bmjopen-2019-030736
Publisher version: https://doi.org/10.1136/bmjopen-2019-030736
Language: English
Additional information: This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Experimental Psychology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/10078032
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