The Meanings of Prognosis: When and How to Discuss It?

Abstract

Prognosis, together with therapy, is one of the physician’s aims when formulating a diagnosis.

These three medical cornerstones have improved thanks to developments in technology and knowledge, albeit privileging the diagnostic and therapeutic aspects, and the prognosis has become a series of outcomes rather than predicting the clinical course of the individual patient’s disease.

The current care model is prevalently based on diagnosis and includes technological and treatment imperatives. This model gives insufficient consideration to the proportionality of treatment, appropriateness and limits of reasonableness, clinical efficacy, ethics, and potential futility of treatment.

These aspects are particularly significant in cardiac intensive care units (CICUs).

Uncertainty is a conditioning aspect in formulating a prognosis. The level of uncertainty is directly proportional to the level of complexity of the patient’s condition, linked to specific characteristics of the primary disease, number of comorbidities, and interaction with non-biological factors (social and family status, financial and environmental factors, and so on).

Prognosis is a difficult and challenging issue to discuss for the physician, patient, and family members. It is a complex process involving the timing of communication (during the acute or stable stages of the illness), the uncertainty and unpredictability of the disease, the extent to which patient and family members want to know how long the patient has to live, and the quality of that time.

Prognosis communication should clarify what can actually be done by the physician, together with the patient’s expectations, “in a context of uncertainty”, while overcoming the inevitable obstacles, not least the psychological and cultural ones of the clinician.