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Development of a tool for defining and identifying the dying patient in hospital: Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL)

developmentThe natural progression of chronic disease involves periods of apparent remission interspersed by exacerbations and, in the year leading to death, multiple hospitalisations. Some indicators of poor prognosis can suggest a patient is nearing the end of life, and have been found useful for initiating discussions with families regarding pre-emptive care planning.1 Yet there is uncertainty of the time, frequency and duration of the next episode of decompensation as well as the ultimate prognosis causing doubts about whether to continue active management. Further, while the majority of people want to die at home, most will die in hospital.

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