Attitude and Self-reported Practice Regarding Prognostication in a National Sample of Internists

Open Access
Publisher Website
Google Scholar
Abstract
AFTER A long period during which prognosis has not been an important focus of medical care,1,2 several confluent contemporary developments are increasing the salience of prognostication for physicians and patients alike. Many of these developments reflect the long-standing linkage between prognosis and its frequent object, death.3 First, the increasing public interest in humane terminal care necessarily requires that medical professionals be more willing to make and act on predictions about the timing of impending death. A physician's prognostic assessment that a patient is "terminally ill" is an essential element, for example, in the withdrawal or withholding of life support from critically ill patients,4 in proposals regarding physician-assisted suicide,5-8 and in qualifying for the Medicare hospice benefit.9 Second, as the avoidance of futile treatment assumes increasing prominence for reasons of justice, beneficence, or cost containment,10-12 prognostication—which is, after all, the fundamental and essential basis for a determination of "futility"—will increase in importance. Third, new technologies, such as genetic testing and prenatal screening, are emerging. While often directed at improving diagnosis and therapy, these technologies also either directly or indirectly yield information with substantial and essentially prognostic significance.13-16 Fourth, the increasing emphasis on patient autonomy in clinical care—with its implicit notion of physicians spelling out for patients various alternative courses of action and the likely results of these actions—requires physicians to generate and communicate predictions, if only to serve as an explicit predicate for patient decision making. Fifth, there is an increasing prevalence of chronic diseases. For patients with such diseases, diagnosis and therapy are often well established, and clinical encounters often center on the anticipation and avoidance of new developments.17

This publication has 22 references indexed in Scilit: