Using intuition or a formal palliative care needs assessment screening process in general practice to predict death within 12 months:A randomised controlled trial
Autor: | Scott A Murray, Robert S. Ware, Josephine M. Clayton, Joel Rhee, Geoffrey Mitchell, Hugh Senior, Patrick C. K. Teo, Sharleen Young, Kirsty Boyd |
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Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
Adult
Male Population ageing medicine.medical_specialty Pediatrics Palliative care media_common.quotation_subject Patient Care Planning law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law General Practitioners medicine Journal Article Humans 030212 general & internal medicine Registries media_common business.industry Palliative Care Australia General Medicine Middle Aged Prognosis Clinical trial Death Surprise Anesthesiology and Pain Medicine 030220 oncology & carcinogenesis Family medicine Needs assessment General practice Female business Intuition Needs Assessment |
Zdroj: | Mitchell, G K, Senior, H E, Rhee, J J, Ware, R S, Young, S, Teo, P C, Murray, S, Boyd, K & Clayton, J M 2018, ' Using intuition or a formal palliative care needs assessment screening process in general practice to predict death within 12 months : A randomised controlled trial ', Palliative Medicine, vol. 32, no. 2, pp. 384-394 . https://doi.org/10.1177/0269216317698621 |
DOI: | 10.1177/0269216317698621 |
Popis: | Background: Population ageing will lead to more deaths with an uncertain trajectory. Identifying patients at risk of dying could facilitate more effective care planning. Aim: To determine whether screening for likely death within 12 months is more effective using screening tools or intuition. Design: Randomised controlled trial of screening tools (Surprise Question plus the Supportive and Palliative Care Indicators Tool for Surprise Question positive patients) to predict those at risk of death at 12 months compared with unguided intuition (clinical trials registry: ACTRN12613000266763). Setting/participants: Australian general practice. A total of 30 general practitioners (screening tool = 12, intuition = 18) screened all patients ( n = 4365) aged ≥70 years seen at least once in the last 2 years. Results: There were 142 deaths (screening tool = 3.1%, intuition = 3.3%; p = 0.79). General practitioners identified more at risk of dying using Surprise Question (11.8%) than intuition (5.4%; p = 0.01), but no difference with Surprise Question positive then Supportive and Palliative Care Indicators Tool (5.1%; p = 0.87). Surprise Question positive predicted more deaths (53.2%, intuition = 33.7%; p = 0.001), but Surprise Question positive/Supportive and Palliative Care Indicators Tool predictions were similar (5.1%; p = 0.87 vs intuition). There was no difference in proportions correctly predicted to die (Surprise Question = 1.6%, intuition = 1.1%; p = 0.156 and Surprise Question positive/Supportive and Palliative Care Indicators Tool = 1.1%; p = 0.86 vs intuition). Screening tool had higher sensitivity and lower specificity than intuition, but no difference in positive or negative predictive value. Conclusion: Screening tool was better at predicting actual death than intuition, but with a higher false positive rate. Both were similarly effective at screening the whole cohort for death. Screening for possible death is not the best option for initiating end-of-life planning: recognising increased burden of illness might be a better trigger. |
Databáze: | OpenAIRE |
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