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Poor prognostication: hidden meanings in word choices
  1. Anne M Kelemen,
  2. Grace Kearney,
  3. Michael Pottash and
  4. Hunter Groninger
  1. Section of Palliative Care, Department of Medicine, MedStar Washington Hospital Center, Washington DC, USA
  1. Correspondence to Dr Hunter Groninger, Section of Palliative Care, Department of Medicine, 110 Irving Street NW, Room 2A68, MedStar Washington Hospital Center, Washington DC, 20010, USA; hunter.groninger{at}medstar.net

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Effective communication of prognosis to patients, families and other medical providers is critical for informed decision-making, particularly for patients at end of life. Research shows that patients who have a realistic sense of their life expectancy tend to approach treatment differently than those who do not.1 ,2 Despite worry among clinicians that providing realistic information will ‘take away hope’, both patients and families report better psychological outcomes as the result of prognosis discussions.3 ,4 Nevertheless, barriers persist. Aside from the practical difficulty of ascertaining a patient's life expectancy, the absence of a standardised language to express prognostic information can further obscure what is already uncertain. For example, the adjective grave—defined by Merriam-Webster as ‘very serious or dangerous to life’—conveys urgency but does not provide a specific time frame.5 Likewise, the phrase ‘poor prognosis’, used frequently in clinical documentation and in conversation with patients, can vary widely in meaning among medical providers. Even ‘hospice eligible’, which typically indicates a prognosis of 6 months or less, often resists such universal interpretation.

We became interested in how clinicians themselves understand language employed …

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