PALLATIVE CARE Not an Exact Science Predicting how long someone has to live is never easy,


but even so, there’s more we can do to support people towards the end of their lives. Professor Bill Noble, Executive Medical Director at Marie Curie, explores the importance of supporting those with terminal illnesses particularly in the face of an inaccurate survival rate prediction.


An accurate prognosis concerning the length of a terminal illness can be a really difficult thing for clinicians to get right, even for people in the advanced stages.


‘‘The study of


clinicians’ predictions of patients’ survival


revealed wide variation in inaccuracies, ranging from an


underestimate of 86


days to an overestimate of 93 days.’’


New research, led by the Marie Curie palliative care research team at University College London (UCL), combined the results of previous studies to define how accurate doctors are at prognostication, to see if there are factors that help some doctors to predict with more precision.


The study, based on 4,642 records of clinicians’ predictions of patients’ survival revealed wide variation in inaccuracies, ranging from an underestimate of 86 days to an overestimate of 93 days.


Although the researchers had hoped to find that some doctors – for example, those who were more experienced


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or older – were more accurate than others, the study found no clear evidence that this was the case.


Prognostication:


A Guessing Game At best, a prognosis of how long someone with a terminal illness has to live, is a calculated guess, so what our researchers found in this study is not surprising. We already know that no two people are the same, and that every illness carries a variety of different possible outcomes depending on the treatment they are receiving.


The Royal College of Nursing (RCN), in their response to this study, pointed out that openness around giving a clear, honest prognosis is crucial in the delivery of good end of life care, even when a definitive answer is not available.


RCN commented: “For a dying person and their loved ones, uncertainty can make a very distressing time much harder to deal with”.


However, this research underlines the fact that, no matter how much we might wish to know the time of our passing, it simply is not possible to do better than describe the possibilities and probabilities of survival times.


Transparency is Key Clinicians and patients should recognise that open and honest


discussions about the future have to include an accurate description of the nature of the uncertainty.


Being able to recognise that someone has a terminal illness, means that as clinicians, we can do much more to help people plan ahead. This usually involves finding the right time to have open and honest conversations with patients and their families about what to expect so they can make more informed choices about their future care options.


‘‘Clinicians and patients should


recognise that open


and honest discussions about the future have to include an


accurate description of the nature of the uncertainty.’’


Whether that’s helping their patients to relieve pain or other symptoms, discussing advance decisions, or giving advice and support to carers, clinicians shouldn’t miss the opportunity to help people with a terminal illness to have the best quality of life in the last days, weeks or months.


www.tomorrowscare.co.uk


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