• geriatrics
• Palliative Care

Three-quarters of older adults visit an ED in the last 6 months of life.1 For older patients with serious, life-limiting illnesses, those who have good awareness of their illness severity have better outcomes. Prognostic awareness is associated with better-informed decisions about patient care,2 improved ability to cope with illnesses3 and increased acceptance of illnesses,4 yielding more patient-centred care at the end of life.

In their EMJ systematic review, Mols et al present the results of a systematic review of patients’ self-assessment of patient outcomes (eg, prognosis) in acute care settings compared with established prognostication tools, perceptions of clinicians or perceptions of caregivers/family.5 Four outcomes were assessed: (1) Need for hospitalisation and length of stay; (2) Severity of illness; (3) Postdischarge quality of life; and 4) Life expectancy. The review demonstrated that patients could predict the need for admission with 64% accuracy, only slightly better than a coin-flip. This finding is likely confounded because patients’ perceptions and preferences may be driving physicians’ decisions to admit them. Furthermore, 68% of patients overestimated the severity of their illnesses, and only 37% predicted their survival accurately. From this review, we conclude that the literature is limited around patient prognostic understanding in …