Project objectives

The 2017 review aimed to:

·       Critically appraise the evidence for clinical assessment tools indicating or predicting the likely death of people within 12 months.

·       Identify populations and settings in which the identified tools could be used.

·       Identify barriers and enablers to successful implementation of the tools.

·       Develop an understanding of the relevance and potential applicability of the tools to the NSW context.

The 2019 review aimed to update the 2017 review.

NSW Agency for Clinical Innovation

Our approach

We undertook a literature search using an agreed search strategy designed to respond to the specific questions. The search strategy focused on studies describing tools that involved:

  • Application of some form of clinical assessment, screening approach or scale in clinical practice; methods that involved assessment of mortality risk using predictors not immediately available to a clinician were excluded although assessment of this was not always straightforward
  • An assessment of the risk of mortality or prognostication according to factors other than clinically relevant events (e.g. onset of a clinical exacerbation, frailty, admission to residential care)
  • Prospective prediction of mortality risk, as opposed to a retrospective analysis of mortality.


The evidence base to support the use of most of the tools identified was relatively poor. There is a considerable amount of research relating to the development and use of palliative care and end-of-life assessment tools. The focus of more recent studies has been on testing the utility of existing tools with different patient groups (age groups, settings or disease categories) or assessing the impact of modifications to these existing tools. More specialised tools tend to have greater predictive accuracy but are of less practical use in clinical settings given their more limited range. Generally, these studies included little discussion of key implementation issues including the training, time and clinical expertise required to administer these tools in practice. The studies also provided limited insight into the practical and operational aspects of using tools prospectively in clinical settings.

The Evidence Check found that the quality of evidence across this body of research is consistently low. There are also significant gaps in the literature relating to the implementation of these tools in clinical settings. More work is needed to validate and assess the practical implications of using these tools routinely in clinical practice.

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