The Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT) is a mortality risk model designed to facilitate end-of-life and advance care planning discussions. This tool utilizes self-reportable information to predict mortality risk in older adults receiving home care, aiding in the timely identification of those who may benefit from palliative care services. RESPECT was developed and validated using a large dataset of older adults in Ontario, Canada.
Development and Validation of the RESPECT Tool
The RESPECT tool was developed using a cohort of over 435,000 adults aged 50 and older receiving home care in Ontario between 2007 and 2012. Researchers used the Resident Assessment Instrument for Home Care (RAI-HC) data to predict 6-month mortality. A proportional hazards regression model, accounting for individual clustering, identified key factors associated with mortality risk.
The model was then validated with a separate cohort of over 139,000 individuals assessed in 2013. Calibration was assessed using Kaplan-Meier survival curves, comparing predicted and observed 6-month mortality rates. To provide clinically meaningful information, 61 risk groups were created based on median survival times, ranging from a few weeks in the highest risk group to over eight years in the lowest.
RESPECT Tool Performance and Implications for Palliative Care
The RESPECT tool demonstrated strong predictive accuracy in both the derivation and validation cohorts. The predicted 6-month mortality risk ranged from 1.54% to 98.1% across the risk groups. Estimated median survival varied widely, from 28 days in the highest risk group to over eight years in the lowest. The validation cohort yielded a c-statistic of 0.753, indicating good discrimination.
This ability to stratify risk allows for more informed discussions about end-of-life care. By identifying individuals at higher risk of mortality, the RESPECT tool can prompt timely referrals to palliative care services. This proactive approach ensures individuals receive appropriate support and care as their needs evolve. Early integration of palliative care can significantly improve quality of life for both patients and their families.
Conclusion: RESPECT Tool – A Valuable Resource in Palliative Care
The RESPECT tool offers a practical and effective method for identifying older adults who may benefit from palliative care. Its reliance on readily available information makes it easily implementable in home care settings. By providing personalized mortality risk predictions, RESPECT empowers clinicians and patients to engage in meaningful discussions about end-of-life care, ultimately leading to improved quality of life and more informed decision-making. The RESPECT tool represents a significant advancement in the field of palliative care, facilitating a more proactive and patient-centered approach to end-of-life care planning.
