At the end of life, these prognoses can become critically important, as they can herald a change from primarily curative or life-prolonging care to primarily supportive or palliative care, a change that clearly impacts clinical and personal decisions.

The irony is that despite its importance, physician prognostication in advanced illness is largely inaccurate and their communication about it is also imperfect. Numerous studies have revealed substantial optimistic bias in the prognoses physicians formulate for their terminally ill cancer patients and additional optimistic bias in the prognoses physicians disclose to these patients. It may be that under-utilization of palliative care at the end of life is related to these prognostic challenges.

1. Identify the two critical tasks physicians undertake in providing patients with advanced illness realistic prognoses.
2. Identify sources of information that can assist physicians in the prognostic estimates they formulate about patients.
3. Identify a framework to guide disclosure of prognoses to patients to meet patients’ informational needs.