RT Journal Article
SR Electronic
T1 Prognostication in palliative care
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 306
OP 310
DO 10.7861/clinmedicine.19-4-306
VO 19
IS 4
A1 Christina Chu
A1 Nicola White
A1 Patrick Stone
YR 2019
UL http://www.rcpjournals.org/content/19/4/306.abstract
AB An accurate prognosis about how long a terminally ill patient has left to live, when disclosed sensitively in open discussions, can facilitate patient-centred care and shared decision making. In addition, several guidelines, policies and funding streams rely, to some extent, on a clinician estimated prognosis. However, clinician predictions alone have been shown to be unreliable and over-optimistic. The factors underlying clinicians’ prognostic decisions (particularly at the very end of life) are beginning to be elucidated. As an alternative to clinicians’ subjective estimates, a number of prognostic algorithms and scores have been developed and validated, but only a few have consistently shown superiority to clinician predictions. Therefore, an element of uncertainty remains and this needs to be acknowledged when having conversations with patients and their families. Guidelines are available to advise clinicians about how to prepare for, participate in and record prognostic conversations.