Predicting and communicating prognosis in palliative care

When Abdelbaset Ali al-Megrahi, convicted of the Lockerbie bombing, was released from a Scottish prison in August 2009, he was freed on compassionate grounds. His doctors pronounced that he was terminally ill with prostate cancer and thought he had only a few months to live. He is still alive today. How Meghari’s prognosis was formulated is not known, but its accuracy may have been improved if his doctors had had access to a tool like the one developed in the linked study by Gwilliam and colleagues (doi:10.1136/bmj.d4920).1

Diagnosis, prognosis, and therapeutics are the three essential clinical skills and prognosis is the least well done. Doctors are rarely trained in formulating prognoses, an nor do they like doing it, so they try to avoid it.2 But in the 21st century much of clinical practice involves caring for patients with advanced, progressive, life limiting illness. Prognosis needs to be restored as a core clinical skill, to optimise the patient’s treatment and planning.

A new science of prognosis is emerging in palliative care. There are two components to the skill of prognosis—formulating the …