hospice guidelines for determining prognosis

^[1]^[2]

Introduction

General guidelines: (see more specific guidelines)

Eligibility:

General guidelines for hospice:

prognosis of 6 months or less as determined by 2 physicians
- specific diagnosis
- combination of factors
- no specific diagnosis necessary
patient & or family must have elected treatment goals directed relief of symptoms, rather than cure of underlying disease
- a "do not resuscitate" status is not required
clinical progression of disease
- multiple Emergency department visits or inpatient hospitalizations
- Karnofsky performance index < 50
- dependence in at least 3/6 basic activities of daily living (bADL)
- progression past stage 7 of functional assessment scale
  - functional assessment tool (FAST) score of 7c or worse^[1]
recent impaired nutritional status
- unintentional & progressive weight loss of > 10 lbs
- serum albumin < 2.5 mg/dL
frailty itself is not a hospice qualifying diagnosis^[2]

↑ ^1.0 ^1.1 Medical Guidelines for Determining Prognosis in non-Cancer Diseases, 2nd edition, Stuart et al (eds), National Hospice Organization, Arlington, VA, 1996
↑ ^2.0 ^2.1 NEJM Knowledge+