Ms Tricia O’Connor1,2, Ms Juliane Samara1,3, Associate Professor Aileen Collier2, Professor Karen Strickland4, Professor Catherine Paterson2
1Clare Holland House, Australia, 2Flinders University, Adelaide, Australia, 3Southern NSW Local Health District, Eurobodalla, Australia, 4Edith Cowan University, Perth, Australia
Biography:
Tricia is a PhD candidate at Flinders University with a particular interest in the care needs of the unresponsive dying patient. She is a specialist palliative care nurse at Clare Holland House Hospice, Canberra, where she has worked for over 18 years. She is a recipient of the ANMC Vivian Bullwinkel Award.
Juliane is a nurse practitioner currently working for Southern NSW Local Health District as a Specialist Palliative Care Nurse Practitioner. Juliane has over 20years experience working in aged care, oncology and specialist palliative care.
Abstract:
Background:
Recent research suggests that the Australia-Modified Karnofsky Performance Status (AKPS) score can help determine timeframes to death. On average, patients were completely dependent and bedbound (AKPS 20) for 24 days before losing decision-making ability (AKPS 10). This grassroots nurse-led research could help drive earlier, more holistic, person-centred care, enabling patients to make timely decisions while they still can.
Aim:
To critically review how nurse-led peer-reviewed research determining timeframes to death can inform bedside practice. A case study of an 85-year-old man with cancer is used to illustrate this important initiative.
Methods:
On discharge to residential aged care, the nurse practitioner (NP) collaborated with the patient and family, alongside the GP and specialists, to determine goals and preferences. The NP applied routine AKPS scoring and clinical assessment to inform prognosis during regular clinical visits. Informed by recent research, the NP identified the trigger of AKPS scores deteriorating from 30 to 20, recognised dying, and developed an end-of-life care plan.
Results:
AKPS scores guided discussions with the patient, extended family members overseas and multidisciplinary team about preferred place of death, voluntary assisted dying, and family travel timing. Using AKPS assessments and closely collaborating with the GP and care teams, the NP coordinated care in residential aged care. Weekly reviews combined clinical expertise and research evidence to guide symptom management, anticipatory prescribing, prognostication, and psychosocial support. When the patient’s AKPS dropped to 20, the family was informed and returned to Australia. The patient died peacefully surrounded by family.
Conclusion:
Frontline problem-solving based on innovative nurse-led research enabled timely, holistic care and informed decision-making when dying was recognised and ‘Code dying’ was metaphorically activated. The case demonstrates the value of translating research into practice for all clinicians and offers practical insights to support clinicians in end-of-life planning discussions based on AKPS prognostication.