Studies have demonstrated that physicians are very poor prognosticians
(Christakis). Christakis demonstrated that for the relevant population
(patients with terminal illnesses being considered or admitted to hospice),
on average physicians overestimated life expectancy by five times actual
life span.
Prognostication Tips
Prognostication for patients with solid tumors is often easier
to estimate than for non-cancer terminal illnesses such as end
stage heart, lung, liver or kidney disease.
When a patient with a metastatic solid tumor which is unresponsive
to conventional therapy becomes completely bed-ridden without
a correctable cause, the expected life span is typically days
to weeks.
Patients with End Stage Renal Disease (ESRD) on dialysis may
live up to 2-3 weeks after stopping dialysis.
Patients who discontinue artificial tube feedings and are unable to take
anything orally may survive one to two weeks. (Remember Terry Schaivo from
Florida?)
Patients with advanced dementia tend to recover from routine infections
even without antibiotics as dementia per se is not an immuno-compromised
state.
Patients with advanced dementia have up to 10% mortality with each UTI
or pneumonia even when treated with antibiotics.
