Give a prognostic range.

Often, from a place of good intention or perhaps overconfidence (or something else), patients and families are given very specific prognoses. “It’s going to happen tonight” or “there’s less than twenty four hours left.” The reality is this: health care providers are very, very bad at estimating prognosis. And if we give a very specific prognosis and are wrong, it often causes tremendous distress and second guessing.

Instead, give a prognostic range. Say “hours to days” or “days to weeks.” Acknowledge the uncertainty, it’s absolutely OK to say you don’t know. Patients and family members often appreciate the honesty. Acknowledge the fact that you don’t have all the answers, and let them know that if you sense things speeding up or changing, you’ll be open and transparent.

Oftentimes knowing that someone is readily available to provide empathetic and honest updates about what’s going on, and answer any questions big or small, is a great source of comfort for patients and their families at the end of life.