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Prognostic awareness of seriously ill older adults in the emergency department
  1. Kei Ouchi1,2,3,
  2. Adrian Haimovich2,4,
  3. Jason Bowman1,2,3
  1. 1 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2 Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
  3. 3 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
  4. 4 Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Kei Ouchi, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; kouchi{at}

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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 …

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  • Handling editor Mary Dawood

  • Contributors All authors contributed equally and substantially to the conceptualisation, writing, editing and analysis of this manuscript.

  • Funding The study was funded by the National Institute on Aging (K76AG064434) and National Center for Advancing Translational Sciences (UM1TR004408).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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  • Systematic review
    Elisabeth Margaretha Mols Harm Haak Mark Holland Bo Schouten Stine Ibsen Hanneke Merten Erika Frischknecht Christensen Prabath W B Nanayakkara Christian Hans Nickel Immo Weichert John Kellett Christian Peter Subbe Marjolein N T Kremers Safer@Home Research Consortium J Alsma M Brabrand T Cooksley Erika F Christensen Harm R Haak Mark Holland Stine Ibsen John Kellett Marjolein N T Kremers Hanneke Merten Elisabeth M Mols Prabath W B Nanayakkara Christian H Nickel Bo Schouten Chris P Subbe Immo Weichtert