A survey of prognosis discussions held by health-care providers who request palliative care consultation

Abstract

Background:

Patient misunderstandings about prognosis may be related to lack of communication.

Aim:

This study aimed to examine prognosis discussions held with hospitalized patients for whom palliative care consultations were requested, and if prognosis discussions did not occur, to explore why not.

Design:

This was a survey conducted over the telephone from a convenience sample of health-care providers who requested palliative care consultations. Respondents were asked about whether prognosis had been discussed with the patient and the topics addressed.

Participants:

A total of 65 health-care providers who called to request a consultation from the palliative care team in a large academic medical center in the United States.

Results:

Of the 65 responses, 45 (69.2%) subjects reported that a prognosis discussion had occurred, while 15 (23.1%) reported that a prognosis discussion had not taken place. Among the surveys reporting a prognosis discussion, a majority of providers responded that most aspects of prognosis were discussed, with the exceptions of life expectancy, survival rates/statistics, and psychosocial concerns. When the prognosis discussion had not occurred, the most common reasons for omitting the prognosis discussion included difficulty in determining prognosis, the perception that the patient already knew his or her prognosis, and the belief that the prognosis discussion was better suited for a different specialty.

Conclusions:

The results of this study highlight the uncertainty that primary team providers in the academic hospital environment have with prognostication, which is a complex process for which this set of providers, composed primarily of medical trainees and nurses, may not have had sufficient training.