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Introduction to the prognostication and recognition of dying Introduction to the prognostication and recognition of dying
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Causes of deaths and illness trajectories Causes of deaths and illness trajectories
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Progressive decline with accelerated end—Cancer Model Progressive decline with accelerated end—Cancer Model
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Progressive decline punctuated with exacerbation—Chronic Organ Failure Model Progressive decline punctuated with exacerbation—Chronic Organ Failure Model
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Long gradual decline—General Frailty Dementia Model Long gradual decline—General Frailty Dementia Model
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Prognostication Prognostication
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Clinical act of prognostication: tools for estimating short-term prognosis Clinical act of prognostication: tools for estimating short-term prognosis
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Clinical prediction of survival Clinical prediction of survival
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Prognostication assignment and prognostic tools Prognostication assignment and prognostic tools
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Generic prognostic tools Generic prognostic tools
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Long-term survival Long-term survival
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Short-term survival Short-term survival
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Disease-specific prognostic tools Disease-specific prognostic tools
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Chronic heart failure Chronic heart failure
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Heart failure risk scoring system Heart failure risk scoring system
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Chronic obstructive pulmonary disease Chronic obstructive pulmonary disease
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Cancer tools Cancer tools
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Performance status Performance status
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Palliative Prognostic Score Palliative Prognostic Score
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Palliative Performance Index Palliative Performance Index
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Advanced dementia Advanced dementia
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Diagnosis of the dying process Diagnosis of the dying process
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Intimidations of dying Intimidations of dying
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Process of dying Process of dying
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Conclusions Conclusions
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References References
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155 Prognostication and recognition of dying
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Published:December 2017
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Abstract
Prognosis is the science of evaluating what is like to happen in term of health outcomes (recovery, death, disability) related to a patient’s condition (cancer, chronic disease, accident). Estimating the likelihood of a life-threatening illness becomes crucial, especially among older people. It allows us to balance the benefits and burdens of diagnostic tests and treatments, to plan with the patient and family by their values, and to take care of physical, psychological, and social suffering when the disease is incurable. Validated prognostication tools are available for cancer, chronic conditions, and advanced dementia to help decision-making in the terminal phase of illness. Recognition of dying and care during the last days/hours of life should be a core competency of every physician. When a patient is actively dying, common signs tend to be present and if symptoms are not well controlled, the dying process may be prolonged and the patient may suffer unnecessarily.
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