"Is there any hope?"

Offer Prognostic Information:

Patients say they don’t want their hope to be taken away. Physicians say that being realistic is important. How you do you balance hope and realism?

All of us clinicians have communication habits. When it comes to prognosis, we’re typically realists, optimists, or avoiders. Realists talk about the data. Optimists look first at the bright side. Avoiders start with ‘no one can predict…’

Patients and families are equally complex. Some want all the details, others cover their ears. How can clinicians get on the same page with the patients and families they serve?

Our road-tested approach is two-fold. First, you have to ask yourself whether a patient might make a different choice if she understood her prognosis more explicitly. Second, you have to find out how much the patient wants to know and what kind of information they want about their future. Our talking map, summarized as ADAPT, lays it out.

Most patients want to talk about the future. But for many, statistics is not how they measure what the future holds. Talking about a future event, like an anniversary or graduation, can be much more tangible and practical than a statistical probability—and might result in planning that reflects both hope and realism. Check out our videos to see how we do it. And note in the presentations how often patients have misconceptions about prognosis—to us this is proof that we clinicians need to do better as communicators.