End stage disease may be prolonged and interspersed by periods of time when the patient seems improved. Symptom and caregiver burden is significant, and the timing of death can be difficult to predict.

An assessment of prognosis helps provide an important framework in which to weigh up the benefits and burdens of therapeutic interventions, to allow patients and carers to be involved in the planning and place of care and to “put their affairs in order”. Prognostication scores are difficult to apply to the individual patient and clinicians overestimate prognosis more frequently than the converse.

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End stage disease may be prolonged and interspersed by periods of time when the patient seems improved. Symptom and caregiver burden is significant, and the timing of death can be difficult to predict.

An assessment of prognosis helps provide an important framework in which to weigh up the benefits and burdens of therapeutic interventions, to allow patients and carers to be involved in the planning and place of care and to “put their affairs in order”. Prognostication scores are difficult to apply to the individual patient and clinicians overestimate prognosis more frequently than the converse.

However, in practice, the patient with progressive renal dysfunction, cardiac cachexia, escalating diuretic doses and recurrent episodes of decompensation requiring hospital admission despite optimally tolerated therapy, or changes in biochemical markers, worsening performance status and increasing symptoms is one that should have a full assessment for supportive and palliative care needs in recognition that they now have end stage disease.