A new screening test has been developed which can be used to help identify a patient’s end of life expectancy. The Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL), aims to assess the viability of either performing life-saving treatments or avoiding potentially harmful procedures that could reduce the quality of life over a patient’s remaining days.
The test, developed in part by University of New South Wales researcher Magnolia Cardona-Morrel, takes into account 29 different criteria to suggest the best course of action for a patient with terminal illness.
Depending on the results, the score would better inform and therefore enable a doctor to have more ‘transparent’ conversations with terminally-ill patients, hence minimising the chances of patients undergoing unnecessary treatments.
“When a patient is diagnosed with a terminal illness their first question is always, ‘Doctor, how long do I have left?’” says Dr Cardona-Morrel. “Doctors see their role as to protect their patients so they don’t like to give them sad or bad news.”
Dr Cardona-Morrel said that although the results can act as a catalyst for doctors to use in discussing the available options with patients, it would “by no means decide the treatment”. Rather, doctors can openly suggest all the options available to them, including surgery, palliative, hospice, or home care.
CriSTAL is currently being used in hospitals in Ireland and the United States and it is expected to be in use in Australian hospitals by the end of the year.
Read the CriSTAL report.
Opinion: CriSTAL makes decisions clear
It can be a daunting decision for doctors of whether or not to administer aggressive treatment for terminally-ill patients – especially when taking into account the expectations of the families of patients as much as the patients themselves. It can be difficult for doctors to make these decisions, because of the need for them to be always seen to be doing as much as they can to extend the lives of their patients.
Unnessarilly administering surgery or aggressive medications, such as chemotherapy, could become a thing of the past, should the CriSTAL assessment be put in place. Instead, doctors would have the perfect entrée for discussing realistic end-of-life options with patients – putting more power into the hands of those suffering from terminal conditions to make a decision on how best to live out their remaining days.
Assessments such as CriSTAL, should be able to help patients make better-informed decisions for themselves. This would remove the burden from doctors prescribing treatments which they may already know will reduce the terminally-ill patient’s quality of life, or indeed, risk them dying during these procedures.
It may also be a blessing for our health-care system, by reducing the costs involved with the prescription of aggressive and expensive interventions that often may not improve the patient’s quality of life. CriSTAL results may not only assist communication between doctors and patients, but also between patients and their families – allowing them appropriate time to discuss realistic, end-of-life management plans, with the knowledge that all that can be done to maintain their quality of life, is being done. This is an opportunity that most of us would welcome.
Most importantly though, CriSTAL will give patients the power to choose how and where they will live out the rest of their days. The results won’t dictate the outcome, rather, that power is put back into the patient’s hands and they can make informed decisions on how best to combat their illness, or to live out their lives on their terms.
What do you think? Would you welcome a test that could tell you how long you have left if you were suffering from a terminal illness? Would it be beneficial for you to be able to discuss your end-of-life options openly with your physician and family? Or are you worried that the results could wrongly infuence your decisions?
