Diagnosing dying – development of a tool for identifying the last days of life

Konferenzpapier/Poster - 26.11.2013


Eychmuller S, Domeisen Benedetti F, Forster M, Haile S (2013). Diagnosing dying – development of a tool for identifying the last days of life.
Konferenzpapier/Poster (Englisch)
Name der Konferenz
Forschungstag (Bern)
Akademie der Wissenschaften Schweiz

Introduction: In End-of-life care recognition or “diagnosis” of the dying process is a key area to address. But clinically assessing the point at which a patient enters the last hours or days of life is a complex challenge and not much research has been done on this topic [1]. Based on this and on an international Delphi process [2] a prospective, observational, longitudinal study has been designed. The aim is to construct and test a tool by estimating the sensitivity and specificity of a set of criteria in recognizing imminent death, defined as death within 7 days, in a population of terminal patients in different settings of care (hospital, hospice and nursing home).
Methods: The research contains 3 phases. Phase1: a population of terminal patients is selected by defined inclusion criteria. A set of 10 categories is observed every second day during max. 7 days (4 observations) by the responsible nurse and/ or physician by questionnaire and written specification for each category collected. Sensitivity and specificity of criteria will be estimated. Phase 2: Criteria that are independently associated with approaching death will be included and a tool constructed. Phase 3: The tool is tested.
First results of phase 1: 246 questionnaires were collected and included for analyses. 77% of patients died during observation time. Main care setting: hospital, main diagnosis cancer (64%), age range 23 - 99 years. After multiple logistic regression a “best fit model” was chosen for further construction of the clinical tool, containing 6 out of the initial 10 categories of clinical observations. Each category was completed by a broad range of detailed descriptions.
Conclusion: This set of criteria and some additional details out of the qualitative analyses will be tested in phase 3. The high commitment of all participating study sites demonstrates the relevance of this project.