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LETTER
Response to: Defining the palliative care patient: its challenges and implications for service delivery Mitchell and colleagues have presented us with evidence that even experienced general practitioners confident in their palliative care skills struggle to define a palliative care patient.1 As other health systems endeavour to emulate the Gold Standards Framework,2 Mitchell underlines the framework’s primary hindrance: trying to answer its first question, “Would you be surprised if this patient were to die in the next 6–12 months?” Disease prognosis remains more an art than a science, and identifying palliative care patients by impending death remains unreliable.3 4 Perhaps then the best way forward is to refocus our definition from predicting death to preserving functional life. Palliative care patients could instead be defined as those with a progressive debilitating
456
disease who are experiencing diminishing quality of life. Quality of life is a quantitatively measured outcome that we know is improved by early and regular palliative care, at least in patients with cancer.5 Provided that we can agree on a reliable survey instrument to measure quality of life in palliative care, we could take the definition of the palliative care patient out of the unreliable realm of forecasting and base it on a more concrete measure of patient well-being upon which treatment can also be benchmarked. In order for us to realise the Gold Standards Framework’s full potential, we need to reliably standardise the way we identify and define a palliative care patient. As with all problem-solving, identifying the problem is the first step. Chad Ahia Correspondence to Chad Ahia, School of Medicine, University of Queensland, Herston, QLD, Australia; [email protected]
Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Ahia C. BMJ Supportive & Palliative Care 2013;3:456. Received 18 June 2013 Accepted 22 June 2013 Published Online First 12 July 2013
REFERENCES 1 Mitchell H, Noble S, Finlay I, et al. Defining the palliative care patient: its challenges and implications for service delivery. BMJ Support Palliat Care 2013;3:46–52. 2 Mitchell GK, Johnson CE, Thomas K, et al. Palliative care beyond that for cancer in Australia. Med J Aust 2010;193:124–6. 3 Christakis NA, Lamont EB. Extent and determination of error in doctors’ prognoses in terminally ill patients: prospective cohort study. BMJ 2000;320:469–72. 4 Haga K, Murray S, Reid J, et al. Identifying community based chronic heart failure patients in the last year of life: a comparison of the Gold Standards Framework prognostic indicator guide and the Seattle Heart Failure Model. Heart 2012;98:579–83. 5 Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733–42.
BMJ Supportive & Palliative Care 2013;3:456. doi:10.1136/bmjspcare-2013-000541
Downloaded from http://spcare.bmj.com/ on July 21, 2015 - Published by group.bmj.com
Response to: Defining the palliative care patient: its challenges and implications for service delivery Chad Ahia BMJ Support Palliat Care 2013 3: 456 originally published online July 12, 2013
doi: 10.1136/bmjspcare-2013-000541 Updated information and services can be found at: http://spcare.bmj.com/content/3/4/456
These include:
References Email alerting service
This article cites 5 articles, 3 of which you can access for free at: http://spcare.bmj.com/content/3/4/456#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
LETTER
Response to: Defining the palliative care patient: its challenges and implications for service delivery Mitchell and colleagues have presented us with evidence that even experienced general practitioners confident in their palliative care skills struggle to define a palliative care patient.1 As other health systems endeavour to emulate the Gold Standards Framework,2 Mitchell underlines the framework’s primary hindrance: trying to answer its first question, “Would you be surprised if this patient were to die in the next 6–12 months?” Disease prognosis remains more an art than a science, and identifying palliative care patients by impending death remains unreliable.3 4 Perhaps then the best way forward is to refocus our definition from predicting death to preserving functional life. Palliative care patients could instead be defined as those with a progressive debilitating
456
disease who are experiencing diminishing quality of life. Quality of life is a quantitatively measured outcome that we know is improved by early and regular palliative care, at least in patients with cancer.5 Provided that we can agree on a reliable survey instrument to measure quality of life in palliative care, we could take the definition of the palliative care patient out of the unreliable realm of forecasting and base it on a more concrete measure of patient well-being upon which treatment can also be benchmarked. In order for us to realise the Gold Standards Framework’s full potential, we need to reliably standardise the way we identify and define a palliative care patient. As with all problem-solving, identifying the problem is the first step. Chad Ahia Correspondence to Chad Ahia, School of Medicine, University of Queensland, Herston, QLD, Australia; [email protected]
Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Ahia C. BMJ Supportive & Palliative Care 2013;3:456. Received 18 June 2013 Accepted 22 June 2013 Published Online First 12 July 2013
REFERENCES 1 Mitchell H, Noble S, Finlay I, et al. Defining the palliative care patient: its challenges and implications for service delivery. BMJ Support Palliat Care 2013;3:46–52. 2 Mitchell GK, Johnson CE, Thomas K, et al. Palliative care beyond that for cancer in Australia. Med J Aust 2010;193:124–6. 3 Christakis NA, Lamont EB. Extent and determination of error in doctors’ prognoses in terminally ill patients: prospective cohort study. BMJ 2000;320:469–72. 4 Haga K, Murray S, Reid J, et al. Identifying community based chronic heart failure patients in the last year of life: a comparison of the Gold Standards Framework prognostic indicator guide and the Seattle Heart Failure Model. Heart 2012;98:579–83. 5 Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733–42.
BMJ Supportive & Palliative Care 2013;3:456. doi:10.1136/bmjspcare-2013-000541
Downloaded from http://spcare.bmj.com/ on July 21, 2015 - Published by group.bmj.com
Response to: Defining the palliative care patient: its challenges and implications for service delivery Chad Ahia BMJ Support Palliat Care 2013 3: 456 originally published online July 12, 2013
doi: 10.1136/bmjspcare-2013-000541 Updated information and services can be found at: http://spcare.bmj.com/content/3/4/456
These include:
References Email alerting service
This article cites 5 articles, 3 of which you can access for free at: http://spcare.bmj.com/content/3/4/456#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
