Facing uncertainty - Pilot testing of a palliative prognostic index training with hospital aged care assessment teams

Background: Prognostic avoidance can delay discussions about older hospital patients’ life expectancy. This pilot study examined the effects of a prognostic training program on hospital clinicians’ knowledge and confidence in identifying older patients at risk of dying. Methods: Fifty-seven clinicians from aged care assessment teams at two Australian hospitals were introduced to the Palliative Prognostic Index, a 5-item checklist indicating prognoses between 3 and 6 weeks. Mixed-methods training evaluation included pre-post-training surveys and semi-structured interviews, conducted three months post-training. Results: Clinicians used a combination of experience, knowledge, and intuition as strategies to generate prognoses. Allied health staff relied on intuition more often than medical and nursing staff. Prognostic tools were rarely used. Pre-post-training comparisons showed significant improvements in clinicians’ knowledge and confidence in identifying signs of dying, particularly amongst allied health. Follow-up interviews highlighted advantages and challenges of using prognostic tools. Recommendations are made for addressing these.