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Invited Commentary
Emergency Medicine
September 13, 2019

Early Identification of People Who Would Benefit From a Palliative Approach—Moving From Surprise to Routine

Author Affiliations
  • 1Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  • 2Department of Palliative Care, Bruyere Continuing Care, Ottawa, Ontario, Canada
  • 3Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada
  • 4Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
JAMA Netw Open. 2019;2(9):e1911146. doi:10.1001/jamanetworkopen.2019.11146

There is ample evidence that palliative interventions, including palliative care consultations, advance care planning, or goals of care conversations, have the potential to improve care for patients who are nearing the end of life. Professional organizations in most fields of medicine recommend the integration of a palliative approach for patients with advanced or incurable illness. Despite this, studies continue to show that many patients, especially those with noncancer illnesses, do not receive palliative care prior to death or receive it only in the final days or weeks of life.1

One of the biggest obstacles to initiating a timely palliative approach is clinicians’ inability to reliably identify people who could benefit from it. Once a patient is identified as having unmet palliative needs, they can have their specific needs assessed and managed. However, clinicians cannot perform comprehensive assessments on every patient they see; they must be selective and focus their attention on those who are most at risk. Thus, there is a need for tools that help clinicians identify the patients who most need help. Ideally, these tools would be accurate, reliable, low-cost, and integrate seamlessly into the existing workflow. The study by Ouchi et al2 presents one possible tool, the so-called surprise question, worded as “Would you be surprised if your patient died in the next one month?” in the context of emergency department visits that lead to admission to the hospital.

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