Prognostication
A patient's prognosis refers to the expected course of his or her disease process, including not only timing of eventual death but also future functional status and quality of life while living, with or without treatment. Understanding prognosis is central to establishing patient-centered goals and making decisions about disease-directed treatment as well as hospice, and represents one of the main elements of discussion when talking about serious news and establishing goals of care. Formulating an accurate prognosis for the neurologic patient presents a challenge for clinicians, who must weigh both subjective impressions and any available objective outcome data carefully. Communicating an estimated prognosis to a patient and his or her family-including talking about the prognostic uncertainty inherent in neurologic diseases-presents its own potential pitfalls. This chapter (1) outlines the central importance of prognosis in neurology, (2) highlights challenges that neurologists face in determining prognosis, and (3) discusses communication of prognostic estimates with neurologic patients and their families.
