Intended for healthcare professionals

Practice Practice Pointer

Discussing prognosis and what matters most for people with serious illness

BMJ 2022; 376 doi: (Published 28 February 2022) Cite this as: BMJ 2022;376:e067572
  1. Justin J Sanders, Kappy and Eric M Flanders chair of palliative care and director, associate faculty1 2,
  2. Leigh Manson, senior program manager3,
  3. Deborah Constien, patient and family adviser4,
  4. James Downar, head of division of palliative care and clinical research chair in palliative and end of life care5 6
  1. 1Palliative Care McGill, Department of Family Medicine, McGill University, Montreal, Canada
  2. 2Ariadne Labs, Brigham and Women’s Hospital and Harvard TH Chan School of Public Health, Boston, MA, USA
  3. 3Health Quality and Safety Commission, New Zealand
  4. 4Madison, WI, USA
  5. 5Department of Medicine, University of Ottawa, Ottawa, Canada
  6. 6Bruyere Continuing Care, Ottawa, Canada
  1. Correspondence to JJ Sanders justin.sanders{at}

What you need to know

  • Serious illness is a health condition that carries a high risk of mortality and either negatively affects a person’s daily functioning or quality of life or excessively strains his or her caregivers. Examples include advanced cancer, end stage organ disease, or motor neuron disease

  • High quality communication that improves awareness of prognosis and elicits patients’ goals and preferences can improve care quality and patient experience

  • Clinicians can use structured, evidence based tools, like the Serious Illness Conversation Guide to engage patients in such communication

  • Health systems can support the delivery of high quality serious illness communication through strategies to identify patients with serious illness, train clinicians, prepare patients and families, and ensure documentation that is accessible across multiple points of care

Technological advances in medical care give clinicians unprecedented capability to prolong life. However, this may not be appropriate for patients with serious illness. Serious illness refers to health conditions that carry a high risk of mortality, poor function and quality of life, and strain on caregivers.1 For people with serious illness, life prolonging treatments may not align with their preferences or help meet their goals, and may increase their suffering and that of their family members. A multi-site observational study on patients with serious illness and a randomised controlled trial on patients with advanced cancer suggest that people with serious illness commonly express goals beside simply living longer. Those who recognise that they are nearing the end of life generally prefer care focused on quality of life and increased time spent at home.23

One US cohort study looked at discussions about end-of-life (EOL) care in more than 2000 patients with advanced cancer. The study45 found that clinicians often failed to engage even their sickest patients in conversations about their goals and preferences until it …

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