Assessing Prognosis

Prognostic considerations

Prognosis plays a vital role in clinical decision making but it is also important for patients and families to understand what is likely to happen and over what time period.

Key points

Information about prognosis may affect patients’ and families’ decisions

Patients’ attitudes to treatment and interventions may shift as prognosis shortens
Personal priorities and preferred place of care may change
Prognosis may affect the sustainability of care arrangements in the community.

Performance state has prognostic significance, especially in advanced cancer

The performance state generally reflects the burden of disease. Rate of change is a global index of disease activity, and correlate to increasing constitutional symptoms (such as, anorexia, cachexia, fatigue).
An Australian-modified Karnofsky Performance Scale (AKPS) score of less than 40 or an Eastern Cooperative Oncology Group (ECOG) performance status score of 3 correlates to a median survival of around 3 months for patients with advanced cancer.

A prognosis in terms of 'days', 'weeks' or 'months' can be reasonably predicted for many patients with cancer.

Australian-modified Karnofsky Performance Scale (36kb pdf)

Specific prognostic guidance (SPICT) is available for a range of advanced non-malignant conditions. CareSearch has developed interactive SPICT (297kb pdf) and SPICT4ALL (307kb pdf) forms for online use.

Palliative care services cannot provide long-term in-patient care.

Families may sometimes need to consider residential aged care if the prognosis is months, and the need for good physical nursing is the main focus of the person’s care.

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