Discussing Prognosis

We designed this talking map to give you a just-in-time route through a complex conversation. Think of it as a series of signposts—you might find that not all apply to a particular patient.

Step	What you say
1. Ask what the patient knows, what they want to know	What have other doctors told you about what your prognosis, or the future? How much have you been thinking about the future?
2. Discover what info about the future would be useful for the pt	For some people prognosis is numbers or statistics about how long they will live. For other people, prognosis is about living to a particular date. What would be more helpful for you?
3. Anticipate ambivalence	Talking about the future can be a little scary. If you’re not sure, maybe you could tell me how you see the pros and cons of discussing this. If clinically deteriorating: From what I know of you, talking about this information might affect decisions you are thinking about.
4. Provide information in the form the patient wants	To provide using statistics: The worst case scenario is [25th percentile], and the best case scenario is [75th percentile]. If I had 100 people with a similar situation, by [median survival], 50 would have died of cancer and 50 would still be alive with cancer. To provide without statistics: From my knowledge of your situation and how you cancer has been changing /responding, I think there is a good/50-50/slim chance that you will be able to be around [on that date/for that event].
5. Track emotion	I can see this is not what you were hoping for. I wish I had better news. I can only imagine how this information feels to you. I appreciate that you want to know what to expect.
	Copyright VitalTalk 2019