Physicians’ estimates of patient survival, or prognoses,
are important to both physicians and patients in all phases of a patient’s
life because they inform both medical and non-medical decisions.
At the end of life, these prognoses can become critically
important, as they can herald a change from primarily curative or life-prolonging
care to primarily supportive or palliative care, a change that clearly
impacts clinical and personal decisions.
The irony is that despite its importance, physician prognostication
in advanced illness is largely inaccurate and their communication about
it is also imperfect. Numerous studies have revealed substantial optimistic
bias in the prognoses physicians formulate for their terminally ill cancer
patients and additional optimistic bias in the prognoses physicians disclose
to these patients. It may be that under-utilization of palliative care
at the end of life is related to these prognostic challenges.
After completing this module you will be able to:
Identify the two critical tasks physicians undertake in providing
patients with advanced illness realistic prognoses.
Identify sources of information that can assist physicians in the
prognostic estimates they formulate about patients.
Identify a framework to guide disclosure of prognoses to patients
to meet patients’ informational needs.
