Imperial College London
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Dr Chris Tomlinson

Faculty of Medicine, Department of Surgery & Cancer

Honorary Research Fellow
 
 
 
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Contact

 

chris.tomlinson

 
 
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Location

 

Burlington DanesHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{White:2018:10.1136/bmjspcare-2018-mariecurie.44,
author = {White, N and Harries, P and Harris, AJL and Vickerstaff, V and Lodge, P and McGowan, C and Minton, O and Tomlinson, C and Tookman, A and Reid, F and Stone, P},
doi = {10.1136/bmjspcare-2018-mariecurie.44},
journal = {BMJ Supportive & Palliative Care},
pages = {376.2--376},
title = {44An evidenced-based heuristics model (or rule of thumb) to improve doctors’ intuition about when patients are imminently dying},
url = {http://dx.doi.org/10.1136/bmjspcare-2018-mariecurie.44},
volume = {8},
year = {2018}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - <jats:sec><jats:title>Introduction</jats:title><jats:p>Evidence suggests that the majority of doctors are not very good at identifying when a patient is dying<jats:sup>1</jats:sup> however there is little training available to improve this skill. Even experts are unable to articulate how they recognise when a patient is dying other than by saying that ‘I just knew’.<jats:sup>2</jats:sup></jats:p></jats:sec><jats:sec><jats:title>Aim</jats:title><jats:p>To understand how expert palliative care doctors recognise a dying person.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Rather than relying on ‘years of experience’ as a surrogate measure of expertise we developed a test to identify which doctors really are the prognostic ‘experts’. The prognostic test consisted of 20 real patient case summaries. Participants (palliative care doctors) were asked to predict whether or not they expected the patient to die within the next 3 days. Those who were the most accurate at this task were deemed to be the ‘prognostic experts’ and were invited to complete an additional online judgement task. In this task it was possible to identify which factors were most influential in their prognostic decision-making.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>19/99 doctors who completed the prognostic test were deemed to be ‘experts’. Of those 14 also completed the additional judgement task. The following factors influenced the experts’ decisions: Cheyne Stokes breathing palliative performance score (PPS) a decline in condition in the previous 24 hours respiratory secretions cyanosis and level of agitation or sedation.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p
AU  - White,N
AU  - Harries,P
AU  - Harris,AJL
AU  - Vickerstaff,V
AU  - Lodge,P
AU  - McGowan,C
AU  - Minton,O
AU  - Tomlinson,C
AU  - Tookman,A
AU  - Reid,F
AU  - Stone,P
DO  - 10.1136/bmjspcare-2018-mariecurie.44
EP  - 2
PY  - 2018///
SN  - 2045-435X
SP  - 376
TI  - 44An evidenced-based heuristics model (or rule of thumb) to improve doctors’ intuition about when patients are imminently dying
T2  - BMJ Supportive & Palliative Care
UR  - http://dx.doi.org/10.1136/bmjspcare-2018-mariecurie.44
VL  - 8
ER  -
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