Prognosis¶

Liana Mosley

Background¶

Prognosis is estimating the likelihood of an outcome (morbidity, mortality) due to a medical condition and can help guide clinicians, pts, and families in medical decision making.
Pts frequently cite life choices rather than medical decisions for wanting to know prognosis.

Tools
- Should be specific to each pt’s situation (type of cancer, transplant eligibility, co-morbidities, etc.)
- Non-disease specific tool: https://eprognosis.ucsf.edu/
Errors
- Studies suggest that clinicians consistently overestimate survival
- Two factors most associated with clinician error
  - More clinical experience correlates with less prognostic error
  - Longer duration of pt-clinician relationship correlates with more prognostic error

Several studies suggest that across age and cultural background, most pts want their physicians to discuss prognostic information with them
Ideally clinicians should discuss when the pt is not acutely decompensating and can process information
Earlier prognostic discussions have been shown to decrease rates of hospitalization and highly aggressive care (chemotherapy, pressors) in terminally ill cancer pts

Common Four-Step approach
- Confirm that the pt/family are ready to hear prognostic information
- Present information using a range: a few days to weeks; 2-4 months
- Allow silence after you provide information; respond to emotion
- Use prognostic information for eliciting end-of-life goals
Ask-tell-ask
- Ask the pt what type of information would be most useful for them
- Provide information
- Ask pt if that answers their question or if they have additional ones
Pairing hope and worry:
- “While I hope that x might happen, I worry that y is a possibility.”

Helpful phrasing for pts and families resistant to discussing prognosis
- “In order to make this decision, it would be helpful if we talked about how much time you might have left to live. What are your thoughts on discussing this information?”
- “If you knew time was short for you, what would be important to you in making this decision?”
The Palliative Care Network of Wisconsin has several helpful “Fast Facts” on determining/ communicating prognosis for specific disease states: