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Continuing Care01:25

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Continuing care describes the variety of health, personal, and social services provided over a prolonged period. The need for continuing care is increasing because people are living longer. Many people do not have families or others to care for them. Continuing care is mainly for patients who are disabled, functionally dependent, or suffering from a terminal disease. It is available within institutional settings or in homes. Examples include nursing centers or facilities, assisted living,...
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Related Experiment Video

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'How long do you think?' Unresponsive dying patients in a specialist palliative care service: A consecutive cohort

Tricia O'Connor1,2, Wai-Man Liu3, Juliane Samara1

  • 1Clare Holland House, Canberra Health Services, North Canberra Hospital, Canberra, ACT, Australia.

Palliative Medicine
|April 24, 2024
PubMed
Summary

Predicting end-of-life duration is challenging. This study found that patients unresponsive for 2 days had a 47% chance of death, aiding clinical decision-making for palliative care.

Keywords:
Australia-modified Karnofsky Performance StatusCohort studydyingpalliative careprognosisprognosticationterminal careterminally illunresponsive

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Area of Science:

  • Palliative Care
  • Gerontology
  • Oncology

Background:

  • Accurate prediction of the length of time to death for unresponsive patients is uncertain.
  • Knowing the remaining time is crucial for end-of-life care planning and clinical decision-making.

Purpose of the Study:

  • To determine the time from unresponsiveness to death.
  • To investigate if age, gender, diagnosis, or care location predict this duration.

Main Methods:

  • Retrospective cohort study of 786 patients aged 18+ receiving specialist palliative care.
  • Analysis of time from Australia-modified Karnofsky Performance Status (AKPS) score of 10 to death.
  • Utilized interval-censored survival analysis, adjusting for covariates.

Main Results:

  • The median time to death after reaching an AKPS score of 10 was 1 day (mean 2.1 days).
  • 47% of patients died within 2 days, and 84% within 4 days of reaching AKPS 10.
  • Age, cancer diagnosis, and gender did not significantly alter the time to death.

Conclusions:

  • This study offers valuable data to enhance clinician confidence in answering "how long" questions at the end of life.
  • Findings can inform critical end-of-life care decisions.
  • Further research with AKPS may improve prognostic certainty throughout the illness trajectory.