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Palliative cancer care - general issues - Management
How should I assess the person's prognosis?
- Attempt to estimate the person's prognosis.
- Discuss this with the person if appropriate.
Clarification / Additional information
- The Prognostic Indicator Guidance (pdf) can be used to help assess prognosis. It is part of the Gold Standards Framework, which aims to optimize the care of people nearing the end of life who are looked after by primary care teams in the community. It includes the question 'Would you be surprised if this patient were to die in the next 6 to 12 months?' to try to identify people nearing the end of their lives [Gold Standards Framework, 2005a; Gold Standards Framework, 2006a].
- Risks associated with assessing the prognosis include:
- Overestimating the length of survival — families may feel 'robbed' of time with their relative.
- Underestimating the length of survival — the person and their family may question the credibility of the source of information.
- It is therefore important to emphasize that an estimate of the person's prognosis is not a guarantee of what will happen.
[Gold Standards Framework, 2005b]
- A discussion of prognosis should involve:
- Identifying the person's own thoughts regarding their prognosis.
- Explaining the difficulty of providing an accurate prognosis.
- Providing a rough estimate only (e.g. days, weeks, months, years).
- Some people may request not to know their prognosis. This should be respected and they should be given the opportunity to discuss it again at a later date.
Basis for recommendation
- This recommendation is based on the Prognostic Indicator Guidance from the Gold Standards Framework, the development of which involved collaboration with the Royal College of Physicians, the Royal College of General Practitioners, GPs with a special interest in palliative care, and national disease associations [Gold Standards Framework, 2005a; Gold Standards Framework, 2005b; Gold Standards Framework, 2006a]. Expert opinion from textbook literature was also considered [Doyle et al, 2004]:
- Estimating the prognosis helps in the planning of appropriate treatment and care [Gold Standards Framework, 2006a].
- If prognosis is not discussed, or predictions are inaccurate, people may make inappropriate treatment decisions, or inadequately prepare for death [Doyle et al, 2004].
- Doctors may lack confidence when predicting how long someone might live, but if the discussion is avoided, people may be less likely to discuss their own fears and worries, resulting in increased anxiety [Doyle et al, 2004].
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