Prognosis issues Flashcards
What is your approach to discussing the prognosis in patients with an incurable disease with limited life-expectancy? - i.e. “how would you discuss the prognosis with him/her?” (6 elements)
Prepare appropriate setting: quiet room, silencing mobile phones and pagers, set-aside enough time, determine in advance whether a patient would like another member of the family present. Interpreter.
Prepare information: talk to specialty consultants involved about estimated prognosis, treatment options - to ensure that the information I deliver is as accurate as possible
Check patient and loved one’s understanding: “to start, I want to make sure we are on the same page. What is your understanding of your medical situation?”, “So that I can understand where we are starting from, I wonder if you have some general sense of how much time you might have, and how you came up with that information?”
Deliver the prognosis information: recognising the uncertainty, I would emphasize the range of possible outcomes, rather than a single number. Best/Worse case scenario. QOL during that time - e.g. some patients may prefer not to be on DRUGS and have shorter but better QOL.
Respond to emotion - pause, and let them express their emotions and support.
Agree on a plan for the next steps: I am increasingly aware that for many patients, “structure is the antidote to despair” and they rely on a sense of plan for the future to help cope.
“At this time, I suggest we focus on getting [further prognostic investigations] so that we can get you back home to be with your family”
