Prognostication of the Last Days of Life

Abstract

Accurate prediction of impending death (i.e., last few days of life) is essential for terminally-ill cancer patients and their families. International guidelines state that clinicians should identify patients with impending death, communicate the prognosis with patients and families, help them with their end-of-life decision-making, and provide sufficient symptom palliation. Over the past decade, several national and international studies have been conducted that systematically investigated signs and symptoms of impending death as well as how to communicate such a prognosis effectively with patients and families. In this article, we summarize the current evidence on prognostication and communication regarding the last days of life of patients with cancer, and future directions of clinical research.

Fatores Associados ao Karnofsky Performance Status e sua Trajetória no Último Mês de Vida em Pacientes com Câncer Terminal

“…Understanding the factors associated with KPS and its evolution in each type of cancer will directly help the care process, favoring individualized and patient-centered care, due to its predictive power 9 . It is necessary that the patients' needs with terminal cancer are met, promoting the quality of death, reducing the inappropriate use of futile strategies, and contributing for the efficient use of resources [10][11][12] .…”

Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit

“… 70 Delayed diagnosis results in “opportunity costs” of postponing primary attention to clinically important outcomes. 71 …”

Uso degli antibiotici nel fine vita

“…Una corretta diagnosi di morte imminente, ovvero un periodo compreso tra i quindici e gli ultimi tre giorni di vita, è essenziale per la definizione di importanti outcomes quali la promozione di un processo decisionale condiviso e la sospensione o non inizio di trattamenti attivi orientati alla guarigione di une evento clinico nuovo, nell'ottica di garantire la miglior qualità possibile di vita e un buon processo del morire. 7 L'inquadramento corretto di una prognosi di fine vita permette inoltre di ottimizzare la comunicazione a pazienti e famiglie, ponendo al centro i valori delle persone in carico, affiancandoli nelle cure di fine vita e promuovendo un ottimale controllo dei sintomi.…”