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Liana Mosley


  • 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.

Estimating prognosis

  • Tools
    • Should be specific to each pt’s situation (type of cancer, transplant eligibility, co-morbidities, etc.)
    • Non-disease specific tool:
  • 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

When to discuss prognosis

  • 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

How to discuss prognosis

  • 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.”


Cultivation of prognostic awareness:

Flowchart of prognostic awareness