Prognosis
Albert A. Kurland in Psychiatric Aspects of Opiate Dependence, 2019
The Council on Mental Health of the American Medical Association in the not too distant past expressed the opinion that prognosis in the opiate addict tended to be poorer than in most other psychiatric disorders. The estimate or prognosis reinforces the need for knowing what might be anticipated to occur in the natural history of the disorder in a patient with specific characteristics. The long-term studies detailing the natural history of addictive behavior have indicated that regardless of treatment there are forces at work within individuals that, in some cases, will ultimately result in a return to abstinence – this has been referred to as the “maturing out” process. In the adult, age and the duration of the addiction may at times have considerable significance in estimating the possible outcome of the addictive disorder. Tending to darken the outlook is an ethnic background, broken home, and a family history of addiction, alcoholism, and crime.
Interlude: Reflections on Dying Dilemmas
Donald Joralemon in Mortal Dilemmas, 2016
The space in between these extremes is the contested territory in death decisions. Degrees of uncertainty about a person’s level of consciousness and/or prognosis reduce the likelihood that treatment will end. Even if the prognosis is certain, mixed evidence for consciousness or suffering can delay a death decision. For example, a person in the late stages of amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s Disease) has a terrible prognosis and may be suffering horribly but nonetheless retains consciousness and is not likely to be considered dead. Advanced Alzheimer’s disease is marked by a virtually complete loss of cognitive capacity and a terminal prognosis but may not be associated with significant physical suffering. Patients in this state are typically kept alive until they succumb to a secondary disease that family and physicians choose not to treat (e.g., pneumonia). The decision to withhold treatment in these cases is an indication that at some point in the disease process death is considered preferable to a meaningless life.
Introductory Remarks
Dongyou Liu in Tumors and Cancers, 2017
Tumor or cancer is an insidious disease that results from an uncontrolled growth of abnormal cells in part(s) of the body. There is a burgeoning interest from health professionals and the general public in learning about tumor/cancer mechanisms, clinical features, diagnosis, treatment, and prognosis. Depending on the types of tissue involved, tumors/cancers are grouped into a number of broad categories: carcinoma, sarcoma, leukemia, lymphoma, myeloma, melanoma, central nervous system cancers, germ cell tumors, neuroendocrine tumors and carcinoid tumors. Prognosis for a given tumor/cancer is usually dependent on the location, type, and grade of the tumor, patient's age and health status. The completion of the Human Genome Project in 2003 and the establishment of The Cancer Genome Atlas in 2005 have offered promises for better understanding of the genetic basis of human tumors/cancers and have opened new avenues for developing novel diagnostic techniques and effective therapeutic measures.
When is it appropriate to deliver a prognosis to Korean persons with acute spinal cord injury?
Published in Disability and Rehabilitation, 2012
Purpose: In cases of complete spinal cord injury (SCI), which has a poor probability of recovery, the timely delivery of a prognosis may be crucial to help patients adapt to their situation. The study aimed to help for choose the appropriate time for delivering a prognosis to persons with SCI. Method: Three hundred and four members of the Korean SCI Association with complete SCI were surveyed regarding the time at which their prognosis was communicated and their views about the appropriate time for prognosis delivery. Demographic and injury characteristics were also collected. Respondents’ experience and opinions on prognosis communication were analysed to assess potential associations with demographic and injury profiles. Results: Participants’ opinions regarding the time of prognosis delivery varied. Many respondents (44.1%) reported that the appropriate time would be within 1 month postinjury, whereas the others felt it should occur either between 1 and 3 months (29.3%) or more than 3 months (10.2%). The comparison of time of prognosis communication with the opinions showed that most would have preferred an earlier delivery of prognosis than they had experienced. Conclusions: Our findings provide insight to physicians on the appropriate time for delivering a prognosis to individuals with complete SCI. Implications for RehabilitationIn cases of complete spinal cord injury, which has a poor probability of recovery, the timely delivery of a prognosis may be crucial to help patients adapt to their situation.The opinions of individuals with spinal cord injury regarding the time of prognosis delivery varied.The comparison of time of prognosis communication with the opinions showed that most would have preferred an earlier delivery of prognosis than they had experienced.
Patient and professional dissatisfaction: A literature review of prognosis communication related to hospital settings
Published in Contemporary Nurse, 2008
An essential element of health care decision making is related to ‘what is going to happen next’ (or prognosis). Patients are often dissatisfied with prognosis communication (Chan & Woodruff 1997; Kirk, Kirk & Kristjanson 2004). Yet there is a paucity of literature on the contributing factors and resulting consequences of prognosis communication. A thematic analysis on prognosis communication applicable to hospital wards was employed. The thematic analysis revealed that patients are dissatisfied with prognosis communication, and this dissatisfaction is related to information giving, understanding, and decision making. There is also evidence to suggest that health care professionals are also distressed and dissatisfied with the current use of prognosis in health care delivery, and this relates to hope, role discrepancies, and emotional labour. Factors identified in the literature as contributing to the current use of prognosis included difficulty with the definition, estimation and communication of prognosis. The contributing factor of the medical model upon prognosis communication is discussed. The suggestion is made that if both consumers and providers are dissatisfied with current prognosis communication, then there should be sufficient relevant research funded, undertaken and utilised to inform training, policy changes and individual clinical practice reflection in the movement towards more patient-focussed, sustainable health care.
Cancer Patients' Desires for Communication of Prognosis Information
Published in Health Communication, 2002
Stan A. Kaplowitz, Shelly Campo, Wai Tat Chiu
A mail survey was sent to cancer patients to determine how often they want, request, and receive a qualitative prognosis (i.e., will they die from the disease?) and a quantitative estimate (how long they will survive). The survey included measures of social and psychological characteristics that were hypothesized to be associated with their desire for and willingness to request prognosis information (N = 352). Major findings are as follows: (a) Whereas about 80% of patients wanted a qualitative prognosis, only about one half wanted a quantitative one; (b) over 90% of those who wanted a qualitative prognosis were given one, but only about one half of those who wanted a quantitative prognosis were given one; and (c) about 15% of those who wanted a qualitative prognosis failed to ask for it, and over one third of those who wanted a quantitative prognosis failed to ask for it. Multivariate analyses indicate that the effects of education on wanting, asking for, and receiving prognosis information are slight, and the effects of sex are essentially nil. Older people were significantly less likely to request and to be given prognosis information. Those who had greater anxiety and who needed to avoid thinking about death wanted, requested, and received significantly less information. Fear had significant nonlinear effects on desire, request, and receipt of quantitative information. Those whose prognosis was worse were less likely to want, ask for, and receive quantitative information. Those least likely to want, request, and be given qualitative information were those who combined a bad prognosis with a need to avoid thinking about death.
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