Timely palliative care – a realist review

Petrova et al. from Cambridge, UK highlight the dangers of using prognostic judgments as the principle way to identify people who should receive palliative care in the community.

“A significant body of evidence from systematic reviews suggests that judgments of proximity of death often have accuracy below chance levels. Furthermore, a range of unintended consequences follow from making the identification of the end-of-life stage central to providing palliative and end-of-life care.”

They cite:

(1) accumulated evidence demonstrating low accuracy of prognostic judgments
(2) many individuals’ orientation towards ‘living and hope’
(3) expanding grey zones between ‘palliative’ and ‘curative’ care
(4) complexity of referral decisions
(5) ambiguous value of having ‘more time’ which can enable patients and carers to prepare, achieve closure, enjoy each others’ presence for longer, but can also be ‘more of a difficult time’.

Petrova MWong GKuhn I, et al. Timely community palliative and end-of-life care: a realist synthesis.