Pearls

	•	A prognosis is a prediction about the future of a patient’s illness, including information about how the disease will affect the quality of life and when it might end a life.
	•	A prognosis is based on what the diagnosis is (the prognosis of appendicitis is different from that of lung cancer) and what treatments are available (the prognosis of pneumonia changed with the introduction of antibiotics).
	•	Physician prognostication in advanced illness is largely inaccurate with physicians.
	•	In aggregate, physicians’ overall survival estimates tended to be incorrect by a factor of approximately three, always in the optimistic direction.
	•	A performance status is a global measure of a patient’s functional capacity and has been shown to predict survival in patients near the end of life.
	•	Dyspnea, dysphagia, weight loss, xerostomia, anorexia, and cognitive impairment are helpful in prognostication.
	•	Integrated prognostication models combine clinical predictors together through analytically determined weights to yield a single patient score that can be mapped to an expected survival. The Palliative Prognostic Index (PPI) is an example of such a tool.
	•	Good communication helps explore patients concerns and alleviate any distress related to prognostication.

Palliative Care