prognosis
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Introduction
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]
More specific terms
- hospice guidelines for determining prognosis
- palliative prognostic measure
- prognosis after surgical resection of colorectal carcinoma
- prognosis for patients with dementia
- prognosis in critical care
Additional terms
- 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
References
- ↑ Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999
- ↑ 2.0 2.1 2.2 2.3 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 - ↑ 3.0 3.1 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: https://www.ncbi.nlm.nih.gov/pubmed/22235089
- ↑ 4.0 4.1 Studenski S et al. Gait speed and survival in older adults. JAMA 2011 Jan 5; 305:50. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21205966
- ↑ 5.0 5.1 5.2 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: https://www.ncbi.nlm.nih.gov/pubmed/10678857
- ↑ 6.0 6.1 Chretien JP Expectation Management. N Engl J Med 2014; 371:1936-1939. November 13, 2014 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25390747
- ↑ 7.0 7.1 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. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25687030 <Internet> 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: https://www.ncbi.nlm.nih.gov/pubmed/25687030 - ↑ Gill TM. The central role of prognosis in clinical decision making. JAMA. 2012 Jan 11;307(2):199-200. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22235093 Free PMC Article
- ↑ 9.0 9.1 9.2 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/27187298 - ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/24826440
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/23967494
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/21300920 Free Article
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/27321609
- ↑ 14.0 14.1 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: https://www.ncbi.nlm.nih.gov/pubmed/28528347
Hall JB. Making recommendations for limiting care in the ICU based on sound prognosis. JAMA 2017 Jun 6; 317:2170. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28528345 - ↑ 15.0 15.1 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: https://www.ncbi.nlm.nih.gov/pubmed/31658374 https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.32575