Trajectory |
Progressive, accelerating deterioration |
Unpredictable, with exacerbations and recoveries |
Slow, progressive deterioration; sudden changes rare |
Treatment |
Curative/life-prolonging therapy often stopped at the time of transition to palliative care |
Disease-modifying therapies provide symptom control; usually continued even for palliation |
No effective disease-modifying therapies; treatment primarily supportive |
Prognostication |
Well-recognized syndromes or functional decline associated with prognosis < 6 mo |
Prognostication challenging, especially beyond 3 mo; patients with “end-stage” disease can survive for years on life-sustaining therapies (e.g., dialysis) |
Prognostication challenging; no reliable models for identifying final months |
Needs/concerns |
Pain/symptom control; fear of death; social and physical supports typically needed only in final weeks or months |
Symptom control; decisions about life-sustaining therapies for organ failure (e.g., ventilation, dialysis, organ transplant); needs for social and physical supports often long standing and may exceed symptom burden |
Functional decline, cognitive impairment greater concerns than fear of dying; symptoms variable |
Typical patient demographics |
Age 45–75 yr; often family caregiver |
Age 70–85 yr; partner more likely to be deceased, or elderly and unable to provide support |
Age ≥ 75 yr; partner more likely to be deceased, or elderly and unable to provide support |
Typical patient location; composition of medical team |
Community dwelling, with increasing visits to acute medical facility; care provided by single or multiple specialists (e.g., oncologist, with transition to palliative care specialist) associated with tertiary care facility |
Community dwelling, with frequent visits to acute medical facility; care provided by multiple specialists or coordinated by general practitioner and a specialist; focus of care may be in tertiary care centre or primary care setting |
Often residents of assisted-living or long-term care facilities; less frequent visits to acute medical facility; care generally provided by general practitioner based at assisted-living or long-term care facility; less affiliation with tertiary care centre |
Professional/societal view of illness |
Clearly viewed as life-limiting |
Often viewed as chronic illness rather than life-limiting |
Often not viewed as an illness |