title: Predicting palliative care needs and mortality in end stage renal disease: use of an at-risk register.
abstract: BACKGROUND
  The Gold Standard Frameworks (GSF) Committee devised Prognostic Indicator Guidance in November 2007 to 'aid identification of adult patients with advanced disease, in the last months or year of life, who are in need of supportive or palliative care'.
  
  
  METHODS
  This research used the GSF `surprise question' to formulate a list of patients predicted to die within 1 year with end stage renal failure and to establish the specificity and sensitivity of this register.
  
  
  RESULTS
  58 patients were added to the list during the follow-up period of which 28 (48.3%) died during the same period giving an annual mortality of 32.2%. In comparison with the patients who died during the follow-up period but were not added to the at-risk register, those on the register had a much higher mortality rate (32.2% vs 7.8%). Identification of patients with chronic kidney disease and reduced life expectancy by this method appears to have a high sensitivity (66.7%) and specificity (77.9%). In particular, the negative predictive value for mortality for those on the at-risk register appears to be very high (88.3%), indicating the very low mortality among those not on the register.
  
  
  CONCLUSIONS
  Patients with chronic kidney disease and a reduced life expectancy can be accurately identified by a multi-disciplinary team using the surprise trigger question with a relatively high sensitivity and specificity. The accurate identification of patients with reduced life expectancy allows appropriate end of life care planning to begin in keeping with patients' wishes and within published guidelines.
authors.affiliation: Department of Renal Medicine, Southend University Hospital, Southend, Essex, UK.
authors.forename: Kennedy
authors.initials: K
authors.lastname: Feyi
authors.affiliation: Department of Palliative Medicine, Southend University Hospital, Southend, Essex, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Klinger
authors.affiliation: Department of Renal Medicine, Southend University Hospital, Southend, Essex, UK.
authors.forename: Georgina
authors.initials: G
authors.lastname: Pharro
authors.affiliation: Department of Renal Medicine, Southend University Hospital, Southend, Essex, UK.
authors.forename: Liz
authors.initials: L
authors.lastname: Mcnally
authors.affiliation: Department of Renal Medicine, Southend University Hospital, Southend, Essex, UK.
authors.forename: Ajith
authors.initials: A
authors.lastname: James
authors.affiliation: Department of Palliative Medicine, Southend University Hospital, Southend, Essex, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Gretton
authors.affiliation: Department of Renal Medicine, Southend University Hospital, Southend, Essex, UK.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Almond
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008017:Life Expectancy; D008297:Male; D010166:Palliative Care; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity
keywords: Clinical assessment; Prognosis; Renal failure; Supportive care