Problem

The first MARC end-of-life project identified gaps in the documentation of older people’s care preferences towards the end of life, using interviews and audits of existing healthcare records. Considerable difficulties in the recognition of dying were highlighted. When staff are not aware or acknowledging that a patient is dying, provision of palliative care and end-of-life conversations may be delayed. Hence, ways to improve early recognition of end-of-life care stages and care needs are required. This project seeks to support clinical staff in the recognition of dying through the use of an existing, validated prognostic tool.

Design

Focus on patients at important points of transition, i.e. when they are being assessed as to whether they can be moved to a different setting such as subacute or residential aged care.

• Prospective, mixed-methods design:
• Phase 1. Baseline/ Pre-training
  a) Semi-structured staff interviews to examine current clinical practice, strategies and knowledge regarding the recognition of dying
  b) Information collected from site’s data management system including a number of admissions, admission source, goals of care, length of stay, service referrals and discharge destination.

• Phase 2. Training
  a) Train staff in the use of a validated prognostic tool
  b) Collect pre-post-training surveys to examine immanent effects of the training on staff’s confidence, knowledge and strategies regarding recognition of dying.

• Phase 3. Follow-up/ Post-training
  a) Repeat semi-structured interviews and data collection through the site’s data management system three months post-training to identify if and how the tool use has affected clinical practice.

Collaborators

NARI, Melbourne Health, Western Health, Northern Health, St Vincent’s Hospital, Deakin University, Monash University, North Western Melbourne Primary Health Network, Austin Health.

Project Summary

MACH-MARC Webinar

On 13 October 2022, we collaborated with the Melbourne Academic Centre for Health (MACH) to host a joint webinar titled ‘Predicting Dying – Challenges and strategies in identifying patients at risk of dying’. MARC researcher Dr Katrin Gerber, Austin Health Geriatrician Dr Paul Yates and Northern Health Palliative Care Physician A/Prof Barbara Hayes presented findings from the READY project. The webinar focused on:

• Applying new knowledge about strategies used to identify patients at risk of dying
• Gaining an in-depth understanding of the usefulness and limitations of prognostic tools in predicting life expectancies
• Reflecting on managing uncertainty at the end of life.

Watch the webinar recording