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Synthesis line · hospice

Quality of Life Trajectory

Single 0-100 line on the hospice dashboard. Combines HHHHHMM, JOURNEYS, and the rolling 7-day percentage of good days from the Lap of Love daily check-in. Three bands: difficult (<40), watchful (40-60), comfortable hospice (>60).

Formula

trajectory = HHHHHMM_norm × 0.4 + JOURNEYS_norm × 0.3 + daily_rolling_7 × 0.3
  • HHHHHMM_norm = (HHHHHMM / 70) × 100. Higher is better; no inversion needed.
  • JOURNEYS_norm = 100 − (JOURNEYS / 80) × 100. Higher JOURNEYS raw score = worse trajectory; inversion makes the trajectory line consistently 'higher is better'.
  • daily_rolling_7 is already 0-100 (percentage of good days in the last 7 days from the Lap of Love daily diary).

Weighting rationale

  • HHHHHMM × 0.4

    HHHHHMM gives the most comprehensive read across seven domains and is the only published instrument with a quantitative threshold (>=35 with each item >=5). Weighted highest.

  • JOURNEYS × 0.3

    JOURNEYS provides decline-signal detail (yelling, breathing, sleep) that HHHHHMM does not cover directly. Weighted equally with the daily diary.

  • Lap of Love daily × 0.3

    The rolling 7-day diary keeps the line responsive to short-term shifts the weekly HHHHHMM and fortnightly JOURNEYS instruments cannot see in isolation.

Bands

  • Comfortable hospice> 60

    Continue current management. Monitor weekly with HHHHHMM and daily with the Lap of Love diary.

  • Watchful40 to 60

    Review pain control and any specific domain that has slipped. Worth a vet conversation in the next few days.

  • Difficult< 40

    Active conversation about quality of life and timing. Please contact your vet today.

Clinical note

The 0.4 / 0.3 / 0.3 weighting is a clinical judgement by Alastair Greenway MRCVS and Claire Greenway BVM&S MRCVS, not derived from validation studies — none exist for end-of-life synthesis lines combining these three instruments. The Phase 2 clinical advisory board reviews this. Where any single instrument is missing, the available components are reweighted so the visible weights still sum to 1; the dashboard's clinical view exposes which components contributed to any given point.