How Should Clinicians Discuss Prognosis With Patients?

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Talking to sick patients about their future health prospects is a challenge.
Talking to sick patients about their future health prospects is a challenge.

Talking to sick patients about their future health prospects is a challenge. It is impossible for anyone to know exactly the course an illness will take.

Physicians have trouble quantifying short-term prognostic estimates. For common diseases like congestive heart failure, physicians can miss the mark by 2 or more years.

A new article published in JAMA Internal Medicine suggests a way to communicate prognosis properly with patients.

“What clinicians most need is not precision about the time ahead or the fortitude to discuss it,” wrote Joshua R. Lakin, MD, of the Department of Psychosocial Oncology and Palliative Care at the Dana Farber Cancer Institute in Boston, Massachusetts, “but rather, a softened approach.”

That softened approach includes using “I” statements to express feelings about the situation. An example is, “I am hoping that you have a long time to live with your heart disease and I am also worried that the time may be short, as short as 5 years.”

“I” statements allow doctors to speak about the future while removing the focus on accuracy of what will happen. This lets the physician be part of the discussion with the patient rather than acting as an all-knowing figure.

“To guide patients through a serious illness, we must recognize our own limitations about knowing the future,” wrote Dr Lakin, “And join patients in a more humble position of hoping and worrying together.”

Reference

Lakin JR, Jacobsen J. Softening our approach to discussing prognosis. JAMA Intern Med. 2019;179(1):5-6

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