✅ Definitions of Phase of Illness, for Use in Palliative Care/Advanced Illness

Stable

Patient in this phase when:

• Patient’s problems and symptoms are adequately controlled by the established plan of care and further interventions to maintain symptom control and quality of life have been planned and family/carer situation is relatively stable and no new issues are apparent.

Phase ends when:

• The needs of the patient and/or family/carer increase, requiring changes to the existing plan of care.

Unstable

Patient in this phase when:

• An urgent change in the plan of care or emergency treatment is required because the patient experiences a new problem that was not anticipated in the existing plan of care and/or the patient experiences a rapid increase in the severity of a current problem and/or family/carer circumstances change suddenly impacting patient care.

Phase ends when:

• The new plan of care is in place, it has been reviewed and no further changes to the care plan are required. This does not necessarily mean that the symptom/ crises has fully resolved but there is a clear diagnosis and plan of care (i.e. patient is stable or deteriorating) and/or death is likely within days (i.e. patient is now dying).

Deteriorating

Patient in this phase when:

• The care plan addresses anticipated needs, but requires periodic review, because the patient’s overall functional status declines and the patient experiences a gradual worsening of existing problem(s) and/or the patient experiences a new, but anticipated, problem and/or the family/carer experiences gradual worsening distress that impacts the patient care.

Phase ends when:

• Patient condition plateaus (i.e. patient is now stable) or an urgent change in the care plan or emergency treatment and/or family/carers experience a sudden change in their situation that impacts patient care, and urgent intervention is required (i.e. patient is now unstable) or death is likely within days (i.e. patient is now dying).

Dying

Patient in this phase when:

• Dying: death is likely within days.

Phase ends when:

• Patient dies or patient condition changes and death is no longer likely within days (i.e. patient is now stable and/or deteriorating).

Deceased

Patient in this phase when:

• The patient has died; bereavement support provided to family/carers is documented in the deceased patient’s clinical record.

Phase ends when:

• Case is closed.

Masso M, Allingham SF, Banfield M, et al. Palliative care phase: inter-rater reliability and acceptability in a national study. Palliat Med 2015; 29: 22–30.

Source

Palliative Medicine 2018, Vol. 32(2) 404– 412

https://journals.sagepub.com/doi/pdf/10.1177/0269216317727157