Documentation of discussions about prognosis with terminally ill patients

Communication with Physicians about Health Care Costs: Survey of an Insured Population

“…Some vignette studies in primary care settings suggest that expressions of clinician uncertainty in the form of "I don't know" or "Let's see what happens" or the use of vague lan guage may have detrimental effects on patient confidence. 160,161 In other studies, 162 however, expressions of uncertainty in the context of an otherwise patientcentered style correlated with improved patient satisfaction.…”

“…158 In one study, most patients with breast cancer knew their prognosis, 159 but more recent stud ies of patients with melanoma and advanced cancer indicate other wise, 137,160,161 suggesting that uncer tain or serious prognoses are with held more often. There appears to be both a norm of silence 161 and a norm of vagueness 162 among physi cians, patients, and caregivers in which euphemisms and discus sions of treatment plans overshad ow more frank discussions of diffi cult topics. When discussions of prognosis do occur, they are usually initiated by physicians.…”

“Knowing is Better”: Preferences of Diverse Older Adults for Discussing Prognosis

“…14 When shared with patients, prognostic information may also facilitate greater patient involvement in medical decision-making. [15][16][17][18][19] Despite evidence suggesting that prognosis is an important tool in the care of older adults with late-life disability, we know very little about the preferences for discussing prognostic information in this population. Moreover, although Latinos, Chinese-Americans, and African-Americans are among the fastest growing groups of American elderly, 20 the extent to which preferences for prognosis may vary across racial and ethnic groups is not well understood.…”

Common myths about caring for patients with terminal illness: Opportunities to improve care in the hospital setting

“…Such an error may be a contributing factor to the unintended undertreatment of pain in hospitals. Given the variability of cancer pain 4 and the difference in time to peak effect depending on the route of administration, 5 it is critical for physicians to understand proper dosing in order to effectively treat cancer pain. Furthermore, many physicians were incorrect about the recommended medications for dyspnea and for agitation, 2 symptoms that are prevalent among patients at the end of life.…”

“…1,2 Recent studies have highlighted inadequate pain and symptom control for hospitalized terminally ill patients, [2][3][4] poor communication about treatment preferences, [5][6][7] and limited or delayed referral for hospice care. 8 -10 Efforts to improve the quality of end-of-life care have been diverse, including increased educational programs, [11][12][13] development of palliative care units in hospitals, 14,15 and greater exposure to palliative care for physicians during residency training.…”