Establishing Prognosis

Establishing Prognosis

Studies have demonstrated that physicians are very poor prognosticians (Christakis). Christakis demonstrated that for the relevant population (patients with terminal illnesses being considered or admitted to hospice), on average physicians overestimated life expectancy by five times actual life span.

Prognostication Tips

Prognostication for patients with solid tumors is often easier to estimate than for non-cancer terminal illnesses such as end stage heart, lung, liver or kidney disease.

When a patient with a metastatic solid tumor which is unresponsive to conventional therapy becomes completely bed-ridden without a correctable cause, the expected life span is typically days to weeks.

Patients with End Stage Renal Disease (ESRD) on dialysis may live up to 2-3 weeks after stopping dialysis.

Patients who discontinue artificial tube feedings and are unable to take anything orally may survive one to two weeks. (Remember Terry Schaivo from Florida?)

Patients with advanced dementia tend to recover from routine infections even without antibiotics as dementia per se is not an immuno-compromised state.

Patients with advanced dementia have up to 10% mortality with each UTI or pneumonia even when treated with antibiotics.

For detailed discussion on prognosis, please go to theĀ module on prognostication

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