Hospice is a program for palliative care, with the primary goal of comfort, during the last 6 months of someone’s life. Predicting when someone has a 6-month prognosis, of course, is not a precise science. Below are some useful guidelines to assist in determining a 6-month prognosis. These are only guidelines, and not “rules.” Any patient that a physician feels has a less than 6-month prognosis is appropriate for referral. Commonly, someone may have multiple conditions (for example, COPD and heart failure) that combined may be felt to have a less than 6-month prognosis.
Symptoms at rest (NYHA class 4), shortness of breath from talking, despite optimal management; Left Ventricular ejection fraction of less than 20%.
Symptoms at rest despite optimal management.
Speaking less than 6 words in a day (FAST score of at least 7a) + a secondary condition (e.g. delirium episodes, stage 3 or 4 pressure ulcer, 10% weight loss) or comorbid condition (e.g. Heart Failure, COPD, chronic kidney disease, chronic liver disease.)
PT/INT greater than 1.5; Serum albumin less than 2.5, plus:
– Ascites that is refractory to treatment or
– History of spontaneous bacterial peritonitis or
– Hepatic encephalopathy or
– Recurrent variceal bleeding or
– Concomitant renal disease
Deciding to stop dialysis or choosing not to start dialysis (creatinine clearance of 15 or less).
Usually 6 month or less prognosis as defined by oncologist. Generally, should have advanced disease with metastases.
Requiring total or nearly total assistance with all activities of daily living and
– Lack of intake sufficient to sustain life and no life-sustaining interventions (choose not to have a feeding tube).
– Having a secondary condition that may shorten prognosis may be taken into account (e.g. Heart Failure, COPD, chronic kidney disease, chronic liver disease)