Recognizing the Dying Patient, When Less Could be More: A Diagnostic Framework for Shared Decision-Making at the End of Life

Abstract

Background: Recognizing dying patients is crucial to produce outcomes that are satisfactory to patients, their families, and clinicians. Aim: Earlier discussion of and shared decision-making around dying to improve these outcomes. Design: In this study, we interviewed 16 senior clinicians to develop summaries of palliative care in 4 key specialties: Cardiology, Vascular Surgery, Emergency General Surgery, and Intensive Care. Setting: Oxford University Hospitals. Results: Based on themes common to our 4 clinical areas, we developed a novel diagnostic framework to support shared palliative decision-making that can be summarized as follows: 1) Is the acute pathology reversible? 2) What is the patient’s physiological reserve? 3) What is important to the patient? Will they be fit enough for discharge for a reasonable length of time? Conclusions: We believe that education using this framework in the medical school and postgraduate curricula would significantly improve recognition of dying patients. This would serve to stimulate earlier conversations, more shared decision-making, and ultimately better outcomes in palliative care and patient experience.