Chapter 1 18 visited the emergency department studied the effect of emergency department-triggered palliative care. They found that patients who had received palliative care triggered by the visit had a better quality of life than patients who received standard care.55 3.3 E stimation of the patient’s functioning and other clinical characteristics To support healthcare professionals in estimating the life expectancy of their patients, it may be helpful to knowwhich factors predict approaching death. Predictors of approaching death can function as triggers for initiating a palliative care approach.56 A predictor that is easy to use is poor performance status (measured using, for example, the European Cooperative Oncology Group (ECOG) Performance Status, World Health Organisation (WHO) Performance status or Karnofsky Performance Score), which is predictive of approaching death in patients with terminal cancer.57-60 The ECOG performance status, depicted below, is scored by the patient ’s clinician with a score from 0 to 5 and is mostly used by clinicians to decide if the patient is fit enough to undergo systemic treatment. Poor performance is usually defined as an ECOG performance score of 3 and 4.61 Table 1. ECOG performance status60 Grade ECOG performance status 0 Fully active, able to carry on all pre-disease performance without restriction 1 Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light housework, office work 2 Ambulatory and capable of all selfcare but unable to carry out any work activities; up and about more than 50% of waking hours 3 Capable of only limited selfcare; confined to bed or chair more than 50% of waking hours 4 Completely disabled; cannot carry on any selfcare; totally confined to bed or chair 5 Dead Apart from poor performance status, the occurrence or worsening of a number of symptoms in the palliative phase can be predictors for approaching death: anorexia, weight loss, dyspnoea, confusion and cognitive decline.62-64 Prognostic models are more complex and including several clinical predictors can help clinicians assess whether patients have a short estimated life expectancy.56, 65 Examples are the Palliative Performance Scale, Palliative Prognostic Index, Palliative Prognostic Score, Glasgow Prognostic Score and Chuang Prognostic Scale.66-70 Most of the aforementioned prognostic models include many predictors of approaching death, which may be unpractical in daily practice. Using predictors or prognostic models for approaching death to identify patients with palliative care needs can be helpful near the end of life to urgently arrange appropriate care. However, approaching death usually means death within three months. Predictors for approaching death are therefore less helpful in early identifying palliative care needs,
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