living your best to the end

Communicating Prognosis at the End of Life

How to tell patients they’re likely to die Health care professionals often have difficulty facilitating hope and coping strategies when managing end-of-life issues.  Advising a limited life expectancy has an obvious impact on the patients, caregivers and their networks ability to remain optimistic. To overcome this health care professionals can offer to answer questions, discuss promising new treatments, treat the patient as a “whole person”, discuss the limitations of end-of-life estimates, present information about palliative care and advice on other alternative treatments. Often this information will need to be staggered to avoid overwhelming the patient. If a patient’s health is deteriorating a time will come in which discussing death and dying becomes important. In the terminal phase the patient and their caregivers may hold unnecessary or misplaced misconceptions about the process of dying. This discussion can do much to alleviate anxiety. Patients’ information needs differ with context, prognostic stage and distribution rates. Though most patients will prefer being kept highly informed and appraised of treatment options this need will differ in relation to the context of their own health and their stage in the prognostic cycle. Further, whilst some patients may prefer an “all-at-once” approach to information, others will prefer it to be dispersed across a series of touch points in a more “piecemeal” approach. Discussing prognosis and end-of-life issues has been identified as an important component of care by patients with progressive life-limiting illnesses, and their families.1,2 Being adequately informed is essential for such patients and their caregivers to participate in decisions about their treatment and care, to set goals and priorities, and to prepare for death. Clinicians...