Asking Permission to Discuss Prognosis
While the majority of individuals desire to have their health care providers discuss prognosis, a substantial minority would not want to discuss prognosis. They may fear the emotional burdens associated with knowing prognosis, feel that prognostic estimates are too uncertain, or doubt that prognostic information could be useful to them. Given this, it is useful to ask for permission to talk about prognosis, as a way to 1) shift the locus of control of the conversation to the patient, and 2) assess their readiness to talk about potentially emotionally challenging aspects of their health.STEPS AND EXAMPLE
In the above videos notice the following steps in how the physician asks for permission to talk about prognosis:
- Ask for permission to discuss prognosis
- Respond appropriately to the patient’s desire to discuss prognosis in a way that respects the patient’s decision
- Leave the door open for future discussions if the patient does not want to discuss prognosis
Take a minute to think about what worked well in this example and what can be done differently.PRACTICE PHRASES
- “Many people have questions about prognosis, or what to expect in the future. I’m wondering if you have those questions?”
- “Do you want to talk about what I think may happen in the future?”
- Thai JN, Walter LC, Eng C, Smith AK. "Every Patient is an Individual": Clinicians Balance Individual Factors When Discussing Prognosis with Diverse Frail Elders. J Amer Geriatr Soc. 2013 Jan 15;61(2):264-9.
- Back AL, Arnold RM, Tulsky JA, Baile WF, Fryer-Edwards KA. Teaching Communication Skills to Medical Oncology Fellows. J Clin Oncol. 2003 Jun 15;21(12):2433-6.
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