Mortality Risk Assessment: A Tool for Planning End-of-Life Care

Credit: unitedpatientsgroup.com

A recent study from the American Association of Nurse Practitioners shows that sharing realistic information with patients about their medical prognosis helps facilitate discussions about end-of-life care. The study, published in the Journal of the American Association of Nurse Practitioners on Oct. 25, 2015, also examined the impact of advanced care planning on patient attitudes and decisions regarding prolongation of life versus comfort care.

The study followed 87 patients (average age 81 years) for six months, all of whom had been recently admitted to a nursing home. At the start of the study, a nurse practitioner completed a mortality risk assessment (MRA) on each participant. The MRA included factors such as age, gender, functional status (how well the person performs activities of daily living) and body mass index. It also took into account the person’s medical history, including factors such as chronic illnesses; hospitalizations and ER visits; intensive medical interventions such as intubation; and unintended weight loss. Based on the number of risk factors present, each participant was assigned an MRA score.

The MRA score predicts how likely it is that a person will die within six to 12 months. Patients were stratified into three risk categories — low, medium and high.

During the course of the study, the nurses prioritized advanced care planning for the patients who had the highest scores.

During the course of the study, the nurses prioritized advanced care planning for the patients who had the highest scores. They also used the MRA to educate patients about their prognoses and help focus discussions about end-of-life goals. Whenever possible, the discussions included family members as well.  

At the end of six months, the number of patients who expressed a goal of comfort care increased by 86 percent. Additionally, 25 percent fewer patients said they wanted to be kept alive at any cost or resuscitated in the event of a cardiopulmonary arrest. The number of hospitalizations for patients who participated in advanced care planning also decreased.

Although small, the AANP study highlights the importance of advanced care planning in providing quality care as patients approach the end of life.

Although small, the AANP study highlights the importance of advanced care planning in providing quality care as patients approach the end of life. MRAs provide a framework within which to open these important, albeit difficult, discussions, and give healthcare professionals an important tool for eliciting information about patients’ values, needs and treatment goals. Most people, when presented with truthful information about their prognosis for survival, express a desire for less, not more, medical care.

Credit: asons.co.uk

In the United States, an astonishing number of chronically ill and medically frail elderly persons are hospitalized each year. Further, many of them are subjected to intensive medical interventions that do nothing to enhance their quality of life. According to one analysis of over 1.8 million Medicare records, 32 percent of hospitalized patients over the age of 80 had surgical procedures performed during their last year of life. Nearly 10 percent underwent a procedure during their last week of life. According to a large-scale study funded by the Robert Woods Johnson Foundation, many of these interventions conflicted with the patients’ expressed treatment goals.

By providing a structure for end-of-life discussions, MRAs facilitate communication between patients and healthcare providers before a health crisis occurs. Hopefully, this small study will lay the groundwork for extending this model to doctor’s offices, clinics and hospitals throughout the United States.