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prognosis

The forecast or prediction of the probable course &/or outcome of a disease. (also see life expectancy) Foreseeing: a physician's silent cognitive assessment Foretelling: what a physician relays to patient & family Physician's prognosis are often wrong & usually optimistic Such errors may occur at both phases (foreseeing & foretelling) Thus, patients are often twice removed from the truth. [5] Procedure: - discussions with patients regarding prognosis for incurable metastatic cancer - address both incurable nature of disease & potential life-prolonging therapies - for example "although their is no cure for your disease, there are treatments that may improve your symptoms & prolong your life" Notes: - self-rated health is the best predictor of functional decline [2] - physicians with more experience have better prognostic accuracy - most types of physicians are prone to error in most types of patients - a stronger physician-patient relationship is associated with a lower prognostic accuracy [5] - prognostic accuracy is best when nurses & doctors agree & feel confident in their predictions about ICU patients [14] - low performance status is the best predictor of poor prognosis in patients with advanced cancer [2] - functionality manifested in activities of daily living are often better at predicting prognosis than performance scores [3] - lack of concordance between quality of communication & understanding of prognosis among surrogates [7] - gait speed is the single best predictor of morbidity. institutionalization & disablity in the elderly [2,4] - does patient expectation effect prognosis ? [6] - physician-surrogate discordance (>=20% difference in patient survival) in 53% [9] - surrogates more likely to be optimistic (43% vs 10%) - misunderstanding physicians' assessments in 1/3 of discordant cases - difference in beliefs [9] - cancer patients who believe in miracles may have an unrealistic understanding of their prognosis [15]

Related

diagnostic imaging prognostic factors after stroke factors associated with poor prognosis in patients with CAD International Prognostic Index life expectancy palliative prognostic index palliative prognostic score poor prognostic factors & criteria for severe pneumonia poor prognostic indicators of hypertension stress testing & imaging findings associated with poor prognosis Study to Understand Prognoses & Preferences for Outcomes & Risks of Treatment (SUPPORT) SUPPORT prognostic model

Specific

hospice guidelines for determining prognosis palliative prognostic measure prognosis after surgical resection of colorectal carcinoma prognosis for patients with dementia prognosis in critical care

References

  1. Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999
  2. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  3. Yourman LC, Lee SJ, Schonberg MA, Widera EW, Smith AK. Prognostic indices for older adults: a systematic review. JAMA. 2012 Jan 11;307(2):182-92 PMID: 22235089
  4. Studenski S et al. Gait speed and survival in older adults. JAMA 2011 Jan 5; 305:50. PMID: 21205966
  5. Christakis NA & Lamont EB Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study. BMJ 320:469-73, 2000 PMID: 10678857
  6. Chretien JP Expectation Management. N Engl J Med 2014; 371:1936-1939. November 13, 2014 PMID: 25390747
  7. Anderson WG et al. A multicenter study of key stakeholders' perspectives on communicating with surrogates about prognosis in intensive care units. Ann Am Thorac Soc 2015 Feb; 12:142. PMID: 25687030 http://www.atsjournals.org/doi/10.1513/AnnalsATS.201407-325OC#.VSSK6Be-1Rk - Chiarchiaro J et al. Quality of communication in the ICU and surrogate's understanding of prognosis. Crit Care Med 2015 Mar; 43:542. PMID: 25687030
  8. Gill TM. The central role of prognosis in clinical decision making. JAMA. 2012 Jan 11;307(2):199-200. PMID: 22235093 Free PMC Article
  9. White DB, Ernecoff N, Buddadhumaruk P et al. Prevalence of and factors related to discordance about prognosis between physicians and surrogate decision makers of critically ill patients. JAMA 2016 May 17; 315:2086. PMID: 27187301 - Azoulay E, Kentish-Barnes N, Nelson JE. Communication with family caregivers in the intensive care unit: Answers and questions. JAMA 2016 May 17; 315:2075 PMID: 27187298
  10. Kim AS, Youn CH, Ko HJ, Kim HM. The survival time of terminal cancer patients: prediction based on clinical parameters and simple prognostic scores. J Palliat Care. 2014 Spring;30(1):24-31. PMID: 24826440
  11. Krishnan M, Temel JS, Wright AA et al Predicting life expectancy in patients with advanced incurable cancer: a review. J Support Oncol. 2013 Jun;11(2):68-74. Review. PMID: 23967494
  12. Seow H, Barbera L, Sutradhar R Trajectory of performance status and symptom scores for patients with cancer during the last six months of life. J Clin Oncol. 2011 Mar 20;29(9):1151-8. PMID: 21300920 Free Article
  13. Cagle JG, McClymont KM, Thai JN, Smith AK. "If You Don't Know, All of a Sudden, They're Gone": Caregiver Perspectives About Prognostic Communication for Disabled Elderly Adults. J Am Geriatr Soc. 2016 Jun;64(6):1299-306. PMID: 27321609
  14. Detsky ME, Harhay MO, Bayard DF et al. Discriminative accuracy of physician and nurse predictions for survival and functional outcomes 6 months after an ICU admission. JAMA 2017 Jun 6; 317:2187. PMID: 28528347 - Hall JB. Making recommendations for limiting care in the ICU based on sound prognosis. JAMA 2017 Jun 6; 317:2170. PMID: 28528345
  15. George LS, Balboni TA, Maciejewski PK et al. "My doctor says the cancer is worse, but I believe in miracles" - when religious belief in miracles diminishes the impact of news of cancer progression on change in prognostic understanding. Cancer 2020 Feb 15; 126:832. PMID: 31658374 https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.32575