How effectively can we predict when someone will die?

If you’re diagnosed with a terminal illness, you might consider asking how long you have left. New research shows just how difficult it is for doctors and nurses to make an accurate prognosis.

“Would you be surprised if this person died in the next few months, weeks or days?”

Clinicians routinely ask themselves this simple question to decide whether someone is getting near to the end of their life – and whether they need to be referred for palliative care.

New research led by the Marie Curie Palliative Care Research Team at UCL has looked at just how effective this method is for making accurate predictions.

The team reviewed 25,718 predictions made using the question over a ten-year period. They found that, overall, clinicians got it wrong in around a quarter of cases (25%).

Many patients lived longer than predicted – over half of those predicted to die within a specific time frame, actually. In fact, clinicians did much better at predicting whether patients would survive. They got that right in around 84% of cases. The research team are carrying out further work to look at more accurate ways of making predictions.

Prediction is tricky

It’s important to recognise when someone has a terminal illness, so they can be given the right care, support and help with planning ahead. But predicting how long someone has to live is a notoriously tricky business.

“An accurate prognosis concerning the length of a terminal illness can be a really difficult thing for clinicians to get right,” says Professor Bill Noble, Medical Director at Marie Curie. “No two people are the same and every illness carries a variety of different possible outcomes depending on the treatment the person is receiving.”

Getting it wrong can mean some patients are referred for palliative care unnecessarily – putting a strain on limited care resources. Worse, it could mean some patients miss out on the crucial care and support they need at the end of their life.

Putting the person first

So what improvements could be made? According to Professor Noble, we currently place too much emphasis on making predictions about something that’s inherently unpredictable – the end of life.  That means we underestimate people’s individual needs.

“Being able to recognise that someone has a terminal illness means that, as clinicians, we can help people do much more to plan ahead,” says Professor Noble. “It usually involves finding the right time to have open and honest conversations with patients and their families about what to expect so they can make more informed decisions about their future care options.”

“Pain and other symptoms associated with terminal illness require treatment regardless of whether someone lives days, weeks or months,” says Professor Noble.

So while improving our ability to make predictions is useful, it shouldn’t be the only focus. What really matters is that clinicians provide the best possible palliative care based on an individual’s needs – regardless of how long they expect someone to live. Putting the person first must always be the priority.

If you or someone close to you has recently been diagnosed with a terminal illness, you can find detailed information and support by clicking here