A practical tool to identify patients who may benefit from a palliative approach: the CARING criteria.
Palliative care is often offered only late in the course of disease after curative measures have been exhausted. To provide timelier symptom management, advance care planning, and spiritual support, we propose a simple set of prognostic criteria that identifies persons near the end of life. In this retrospective cohort study of five prognostic indicators, the CARING criteria (Cancer, Admissions > or = 2, Residence in a nursing home, Intensive care unit admit with multiorgan failure, > or = 2 Noncancer hospice Guidelines), logistic regression modeling demonstrated high sensitivity and specificity for mortality at 1 year (c statistic > 0.8). A simple set of clinically relevant criteria applied at the time of hospital admission can identify seriously ill persons who have a high likelihood of death in 1 year and, therefore, may benefit the most from incorporating palliative measures into the plan of care.
Fischer
Stacy M
SM
Division of Health Care Policy and Research, University of Colorado Health Sciences Center, Denver, Colorado 80206, USA. stacy.fischer@uchsc.edu
Gozansky
Wendolyn S
WS
Sauaia
Angela
A
Min
Sung-Joon
SJ
Kutner
Jean S
JS
Kramer
Andrew
A
D000368:Aged; D015331:Cohort Studies; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D020380:Needs Assessment; D010166:Palliative Care; D010343:Patient Admission; D015203:Reproducibility of Results; D012189:Retrospective Studies