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| When does the 'end of life' phase begin? |
By definition, the 'end of life' phase will end in death.
Definition of its beginning is variable according to individual patient and professional perspectives.
In some cases it may be the patient who first recognises its beginning.
In other cases it may be the judgement of the health or social care professional or the
team responsible for the care of the patient.
In all cases, as long as the patient agrees, the beginning is marked by
a comprehensive assessment of supportive and palliative care needs.
Professional judgement may be informed by the use of a range of indicators, which include:
- The Surprise Question. Would you be surprised if the patient were to die in the next 12 months
- Choice. The patient with advanced disease chooses that they wish to receive care for comfort only
- Need. The patient with advanced disease is in special need of supportive/palliative care
- Clinical Indicators. Specific indicators of advanced disease for each of the main groups - people with cancer, organ failure, elderly frail/dementia
(Source: Gold Standards Framework Programme, 2006)
End of life does not normally begin earlier than one year before death and for
most individuals it may come much later than that. However for people with certain long-term
conditions, discussions with individuals about end of life may start much earlier
e.g. at the point of recognition of incurability.
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