Development and Validation of the End-of-Life Assessment Tool for Advanced Dementia: A Multi Method Study.
Carolyn Bourke, Lynn Chenoweth, Ekavi Georgousopoulou and 1 others
PMID 40767121WHAT IT FOUND
In 113 residents with advanced dementia, a 27-item nurse assessment with a score of 14.5 or higher flagged risk of death within 180 days, but it was much better at spotting risk than excluding it.
Key findings
01In the field test, a score of 14.5 out of 27 was the best cut-off for identifying risk of death within 180 days, but specificity was 0.386.
02In the 8-person pilot, the whole tool had good test-retest reliability, but 4 items had slight or fair agreement and 2 items had no agreement.
03RNs and expert panellists helped develop the tool, and RNs judged it relevant, comprehensive, comprehensible, and acceptable.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The field test used 113 people from 11 dementia-specific units in one Australian provider, so it may not represent other aged care services. The pilot was very small, with 8 participants, because COVID-19 restrictions limited access to aged care homes. The tool's specificity was 0.386, so it was poor at excluding people who did not die within 180 days. The study did not test whether using the tool improved symptoms, care planning, quality of life, or decisions by families. Delphi consensus used a 70% threshold, and two items below that threshold were retained after author judgement.
Declared interests
The authors declared no conflicts of interest. The paper does not report who funded the work.
The easy way to misread this
Do not treat a score of 14.5 out of 27 as a stand-alone prediction of death within 180 days. The specificity was 0.386, and the study did not test whether using the tool improved patient care or family decisions.