Palliative Care Wales
New diagnosis or change in prognosis group

Examples of clinical prognostic indicators include the following:

 These are broad estimates for the purpose of planning management only.

 The palliative care phase is the stage of the patient’s illness. Palliative care phases are not sequential and a patient may move back and forth between phases.

Phase definitions  are as follows :

  • Phase 1: stable – this covers all patients not classified as unstable, deteriorating or terminal. The patient’s symptoms are adequately controlled by established management. Further interventions to maintain symptom control and quality of life have been planned. The situation of the family/carers is relatively stable and no new issues are apparent. Any needs are met by the established plan of care
  • Phase 2: unstable – this covers all patients who are experiencing the development of a new unexpected problem or a rapid increase in the severity of existing problems, either of which require an urgent change in management or emergency treatment. The family/carers experience a sudden change in their situation which requires urgent intervention by members of the multidisciplinary team
  • Phase 3: deteriorating – the patient experiences a gradual worsening of existing symptoms or the development of new but expected problems. These require the application of specific plans of care and regular review but are not urgent or emergency treatment. The family/carers experience gradually worsening distress and other difficulties including social and practical difficulties as a result of the patient’s illness. This requires a planned support programme and counselling as necessary
  • Phase 4: terminal – death is likely in a matter of days and no acute intervention is planned or required. The use of frequent usually daily interventions aimed at physical, emotional and spiritual issues is required. The typical features in this phase may include:
    • profoundly weak
    • essentially bed bound
    • drowsy for extended periods
    • disorientated for time and has a severely limited attention span
    • increasingly disinterested in food and drink
    • finding it difficult to swallow medication
    • the family/carers recognise that death is imminent and care is focussed on emotional and spiritual issues as a prelude to bereavement
  • Phase 5: bereavement – death of the patient has occurred and the carers are grieving. A planned bereavement support programme is available including referral for counselling as necessary. Record only one bereavement phase per patient – not one for each carer/family member