LAUSR

BACKGROUND Eligibility to access the Victorian Voluntary Assisted Dying (VAD) legislation requires that people have a prognosis of 6 months or less (or 12 months or less in the setting of a neurodegenerative diagnosis). Yet prognostic determination is frequently inaccurate and prompts clinician discomfort. Based on functional capacity, clinical and biochemical markers, prognostic tools have been developed to increase the accuracy of life expectancy predictions. AIMS This review of prognostic tools explores their accuracy to determine 6-month mortality in adults when treated under palliative care with a primary diagnosis of cancer (the diagnosis of a large proportion of people who are requesting VAD). METHODS A systematic search of the literature was performed on electronic databases Medline, Embase and Cinahl. RESULTS Limitations of prognostication identified include: (i) prognostic tools still provide uncertain prognoses; (ii) prognostic tools have greater accuracy predicting shorter prognoses, such as weeks to months, rather than 6 months; and (iii) functionality was often weighted significantly when calculating prognoses. Challenges of prognostication identified include: (i) the Area Under Curve (a value that represents how well a model can distinguish between two outcomes) cannot be directly interpreted clinically; and (ii) difficulties exist related to determining appropriate thresholds of accuracy in this context. CONCLUSIONS Prognostication is a significant aspect of VAD and utility of the currently available prognostic tools appears limited but may prompt discussions about prognosis and alternative means (other than prognostic estimates) to identify those eligible for VAD. This article is protected by copyright. All rights reserved.