April 2017 –
“The point of prognostication is not to be right, but to help people prepare” – Atul Gawande, M.D.
Asking -“Would I be surprised if this patient died in the next year?”—can improve end-of-life care by identifying patients with a poor prognosis who would benefit from a change in their medical care to better align with life goals.
A “Yes” answer to the surprise question was more predictive than prognostic tools, other disease factors and disease stages at identifying hospice eligibility. Chronically ill patients and their families benefit from having time to reorder their priorities and plan. We find this benefit is more important to patients than the discomfort of hearing difficult news about survival.
The word “prognosis” is medical jargon. Communication experts suggest using direct, simple language, like: “I can tell you what I commonly see in patients with your condition.” Or “Would you like to know what the next year might look like? It might help you make plans.” Or “We are in a different place with your health now. What is most important to you?”