Prognosis

Author: Jenny Wei, DO

Key Points

Prognostication is an important but underused skill in clinical practice. It is a skill that highly impacts medical decision-making in daily clinical practice. 

In patients with advanced of terminal illness, prognostication aids in discussions about advanced care planning. With advance care planning, patients and families are better prepared for events that may occur at the end of life. This may help patients and families facing advance illness maintain a sense of control. 

Prognostication has influences on clinical administrative issues as well, such as the determination of hospice admission criteria for different disease states. 

Prognostication requires the clinician to be aware of the natural progression of diseases, while taking into account other patient-related factors such as comorbidities. An in-depth knowledge about the different therapeutic options, along with the risks and benefits of each option, is also required to determine prognosis. 

Another important factor is the communication of prognosis to the patient and family; news about prognosis should be delivered in a clear and compassionate manner. 

Clinicians tend to overestimate prognosis. There are many tools that can be used to aid in prognostication in many diseases; the clinician should be aware of the tools and resources to help improve accuracy.

 

Overview

The majority of advanced disease trajectories fall into one of three categories.

 

Prognosis Image

 

 

Prognostication Tools

Several prognostic tools and scales are available. The most commonly used ones are primarily based on the patient's functional status, and they include the following:

There are several disease-specific prognostication scales that are available for different organ specific diseases that have been validated: The use of disease-specific prognostication tools can improve the clinician's accuracy in determining prognosis. In addition to the tools, the other variable that should be accounted for also includes physician experience and intuition.

Approach to discussion about prognosis

First, the clinician should establish patient's desire to discuss prognosis. Next, be sure to address emotional and informational concerns. The clinician should be open and honest, and the information should be delivered in a clear and concise manner. It is often times important and useful to be empathic and acknowledge uncertainty. The other important take-home point is that it is best to deliver prognosis in terms of timeframe, rather than specific time periods. Use terms like "hours to days," "days to weeks," "weeks to months," or "months to years." 

 

References

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