End-of-life care is not a topic that most individuals are keen to discuss until they are confronted by the reality that death is a part of life. Western culture and medicine have a strong aversion to death. After all, doctors have sworn an oath and are trained to treat illness, not prepare their patients for death. However, for older frail Canadians suffering from severe illness such as heart disease, cancer, Alzheimer’s and dementia, preparing for death is an inevitable fact of life. While it’s no secret that most patients with advanced illness prefer to die in the comfort of their homes or home-like environment, in the presence of loved ones, less than one in five receive adequate home care in their final years of life.1
Although doctors and nurses generally have a good idea when a patient is about to die, up until now, it’s pretty difficult to predict how long a frail person has to live beyond a few weeks. A group of researchers, led by Dr. Amy Hsu, have created a calculator that helps to answer just how long a person has to live. The Risk Evaluation for Support: Predictions for Elder-life in the Community Tool (RESPECT) is a prognostication calculator that estimates how long a person has to live, using the responses of 17 questions about their health and ability to care for themselves. This risk communication tool identifies when a frail person may be nearing the end of life and provides information that helps to determine their care needs.2 RESPECT can encourage patients to initiate a conversation with caregivers and their physician to help assess their care needs as they are nearing the end of life. According to the data, Dr. Hsu has noted that many Canadians do not receive palliative care in their final weeks. Studies have shown that patients receiving palliative care reported fewer symptoms, improved quality of life, and less depression and anxiety than those who receive standard care.3 In some cases, increased access to palliative care may even reduce the need for medical assistance in dying (MAiD).4
Everyone hopes to live a long and healthy life. However, as we age and our bodies deteriorate, we will all have to make important decisions regarding our health and well-being. RESPECT allows older frail Canadians and their loved ones to do that.
This month, research on (RESPECT) was published in the Canadian Medical Association Journal (CMAJ). Dr. Hsu is a faculty member and lecturer in the Department of Family Medicine at the University of Ottawa. She is also an investigator at the Bruyère Research Institute and holds a uOttawa Brain and Mind Bruyère Research Institute Chair in Primary Health Care in Dementia. This research was co-led by Dr. Douglas Manuel, Professor in the Department of Family Medicine, and Dr. Peter Tanuseputro, Assistant Professor in the Department of Family Medicine and Research Chair in Palliative Care and Predictive Analytics.
1 Hsu AT, Manuel DG, Spruin S, Bennett C, Taljaard M, Beach S, et al. Predicting death in home care users: derivation and validation of the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT). CMAJ. 2021;193(26):E997–1005; DOI: https://doi.org/10.1503/cmaj.200022
2 RESPECT [Internet]. Projectbiglife.ca. [cited 2021 Jul 16]. Tiré de : https://www.respect.projectbiglife.ca/
3 Palliative care improves quality of life [Internet]. Nih.gov. 2017 [cited 2021 Jul 16]. Tiré de : https://newsinhealth.nih.gov/2017/01/palliative-care-improves-quality-life
4 Gallagher R, Passmore MJ. Canada needs equitable, earlier access to palliative care. CMAJ. 2020;192(20):E559.