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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. 1Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
  4. 4Department 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}bwh.harvard.edu

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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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Footnotes

  • 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