Prognosis & Hope: Step Two (Professional Track)

STEP TWO: CONVERSATION WITH OTHERS                                               30 min.

ACT AGREEMENTS AND DIALOGUE

Trust the power of collective wisdom as you engage with others‒ using the lessons from the video as a jumping board for sharing.  Focus on the questions that can best support your role and experience as caregiver.

The Art & Science of Prognostication Series
Lesson Five: Prognosis & Hope

ACT Step Two

1. “In other words, the ‘Scholar” role promotes ‘Foreseeing’, while the ‘Communicator’ role promotes ‘Foretelling’. Foreseeing may be regarded as a series of scholarly activities that begin with the knowledge translation of available data on prognostic factors, instruments, and tools, followed by the computation of a prognostic estimate. Successful Foretelling is dependent on the physician being effective at ‘breaking bad news’. Thus, physicians must develop skills to deliver prognostic estimates in a gentle and sensitive, yet, confident manner. (Prognosis: The ‘missing Link’ within the CanMEDS Competency Framework.” 2014)

2. “On one hand, foreseeing is fairly straight forward. We have more and more evidence-based prognostication tools available to us. There’s more and more information that’s disease specific, yet there’s still this human element that shades our judgement.” –Soul & Science Lesson

3. “From the perspective of a profession that faces delivering difficult news frequently . . . there are barriers that make it difficult actually executing conversations, especially those involving end of life or palliative care, for a variety of reasons. One of the most critical steps is the ‘work before the work.’ Often there is some lead time to prepare a family and patient in terms of what news may be evolving. And the way you do that prework can make the actual conversation much more productive, helpful, thoughtful, compassionate, and empathetic.” - William Maples, MD

4. “‘Will my congestive heart failure ever go away?’ ‘Just what will the diabetes do to me?’ ‘Does this cancer mean I'm going to die?’ These questions demand answers that will shape how patients relate to their illnesses. Prognosis affects their lifestyle choices, health care decisions, and overall outlook. Yet, many physicians dread responding to such questions.’”(James Tulsky, M.D.”Death Foretold: Prophecy and prognosis in medical care” 2000)

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