A diagnostic accuracy study for predicting who should have an Advance Health Directive (AHD)

Validation of CARING Criteria


Lay Summary

Advanced health directives are legal documents that outline patients’ desires for end-of- life care. For individual’s nearing the end of their lives, advanced health directives are an important part of their treatment plan. This is because they tell health care providers about the patient’s wishes regarding treatment near the time of death. However, very few patients hold these documents. This study looks to see whether we can easily identify individuals who are nearing the end of their lives, and therefore, should have an advanced health directive. The research is an initial step in increasing the number of individuals who hold advanced health directives.

In identifying those people who are nearing the end of their lives, we will utilise a clinical tool called the CARING criteria. This tool was designed in the United States and uses demographic and clinical information to identify patients who are likely to die within twelve months. In its original setting, the CARING criteria was highly accurate. However, no research has examined whether this tool is valid in the Australian Emergency Department setting. Therefore, we will assess the tool by looking at the medical charts of 1000 patients presenting to the Emergency Department. We will use the information in these charts to determine which patients meet the CARING criteria, and therefore, likely to have a limited life expectancy. After 12 months, we will conduct a search of the state death registries to determine whether individuals have deceased. We will then determine how accurate the CARING criterion is for predicting mortality.

If the tool is accurate it can be applied to all patients presenting to the Emergency Department and provide advanced health directive counselling to those who meet the criteria. This will ensure that the care provided to patients at the end of their lives is sensitive and meets the needs of patients




Amount Awarded


Grant Scheme


Principal Investigator:
Dr Philip Richardson

Co Investigators:
Dr Jaimi Greenslade
Dr Kevin Chu


CONTACT US +61 7 3720 5700 info@emfoundation.org.au 2/15 Lang Parade Milton Qld 4064