What screening tools or signs do you use to predict if a cancer patient is near end-of-life?
For most of us, long-time practicing oncologists, all we have to do to determine that one of our patients is at the end of their life is to be in the same room with them.
No special computer programs or calculators are needed. Just look closely at the patient's current weight, their level of conscio...
When I see patients with incurable cancers, I usually ask at the first visit, whether they have a living will and what it says. Very few people seem to have filled one. I give them the state form to fill, but that form is very vague. I do recommend no resuscitation if the heart stops beating, as the...
If, by near end-of-life, we mean we would like to predict if a patient has hours to days to live, then I think the most valuable signs to look for include a decreased response to verbal stimuli, decreased response to visual stimuli, nonreactive pupils, an inability to close eyelids, hyperextension o...
It is very true that the "surprise" question does not adequately perform in identifying people who may be nearing the end of life. There are no other standardized screening tools that I use however. Therefore, the "surprise question" is the most frequently used because it makes clinicians at least t...
I suppose there isn't a good and satisfactory universal rule for a "near-end-of-life" predictive biomarker. Again, by the time of truly near-end-of-life care, care with the heart can be more important than caring with science, although both are essential. Depends on how one defines "end-of-life" and...
I wanted to add to the discourse regarding this question from a non-cancer specialist, since I truly believe this is something that we should all do better at. Data show that while roughly 70% of Americans prefer to die at home, only about 30% do. My personal lens: I am an academic hospitalist pract...
We know physicians are overly optimistic about survival prediction, and we are 'surprised' when death occurs. Several predictive models have been developed that can help improve accuracy. (Chow et al., PMID 11527298). Many of these require easily accessible data, including albumin and performance st...
It is often true that seeing and examining a patient helps the practitioner get a sense of life expectancy. However, as physicians, we need evidence-based tools to support our general gestalt. A plethora of cancer-specific models to help the clinician has been published. This is one area where (drea...