Why is giving an early prognosis important?

  • It may provide reassurance.
  • It may help create realistic expectations for the patient, family and carers.
  • It allows for future planning and appropriate goal setting which in turn
    • Enables referral to appropriate services.
    • Enables timely discharge planning, and where appropriate application for care arrangements and equipment / adaptations.

What matters to family and carers in giving a prognosis?

  • Can we hope for good recovery?
  • Can we at least be reassured that severe disability will not be the outcome?

What are the risks in giving an early prognosis?

  • Undue emotional upset for patients, families and carers.
  • If conflicting advice is given by different clinicians, it leads to confusion and greater distress.
  • If advice is inaccurate it leads to undue optimism or pessimism
  • If early advice is over-optimistic, it leads to disillusionment with rehabilitation providers, who are seen as not matching expectations that were set. This in turn leads to failure to accept rehabilitation team recommendations if plateau in recovery is lower than expected recovery.

Difficulties in estimating prognosis:

  • It is difficult to get the right balance in maintaining hope, but not giving unrealistic expectations.
  • There is a limited knowledge base upon which to base prognosis, and there are few reliable predictors or threshold values for predicting outcome.

Issues Which Arise in Estimating Prognosis
What to Say and What NOT to Say about Prognosis Following Brain Injury