How To Estimate A Six Month Prognosis From Hospice By The Bay

In order for a patient to make medical decisions that reflect his or her values and desires, the patient should have an accurate medical prognosis.

But medical prognosis can be subject to significant uncertainty. What follows are resources for determining a patient’s medical prognosis to the extent possible.

Resource (1) gives us excellent resources on determining medical prognosis.

The following excerpt is from Resource (1) below

On average, hospice patients live about two-and-a-half months after being given a six-month prognosis. This means most patients who come into hospice care were actually eligible for services months before the referral was made. Patients miss outon the benefits of our comprehensive services
and support when the referral is made too late.To help you determine the earliest time a patient is hospice eligible, refer to the following information [Click on the links below to be taken my posts to the specific section of the document]:
• How to Estimate a Six-Month Prognosis [this post]
CMS’ Disease Specific Criteria
Decline in Clinical Status Guidelines
• NYHA Functional Classification for Congestive Heart Failure
The Palliative Performance Scale
The Functional Assessment Staging (FAST) for Hospice

How to Estimate a Six-Month Prognosis
A patient is eligible for hospice when 1) he has less than six months to live, and 2) he chooses to forego aggressive curative treatment. While we can help you make that six-month determination ——just call Hospice by the Bay 24/7 for a patient evaluation or consultation —— in general, there are two paths to hospice eligibility:

1. One Major Terminal Diagnosis
Your patient meets CMS’ ‘‘Disease Specific Criteria’’ listed below.

2. Multiple Comorbidities Contributing to Terminal Decline (formerly Debility and Decline):

Your patient has multiple signs and symptoms that suggest a terminal course, but does not meet the current ‘‘Disease Specific Criteria’’ for any one diagnosis.

Please see pages 1-5 for ‘‘Disease Specific Guidelines.’’

Often a combination of diagnoses is accelerating decline and, if we wait until one diagnosis meets the ‘‘Disease Specific Criteria,’’ the referral may be too late to be of maximum benefit.

In these cases, please refer to the ‘‘Decline in Clinical Status Guidelines’’ listed on page 6. This list of elements of decline gives examples of how to document your patient’s terminal trajectory. A patient does not have to meet all the criteria on the list. By
documenting several areas of decline, you can paint the picture of a poor prognosis.

For specific diseases and decline in functional status criteria see my post Links To Prognoses Based On CMS’ Disease Specific Criteria For Hospice Care From Hospice By The Bay.

Resources:

1. Determining Hospice Eligibility In Terminally Ill Patients Hospice by The Bay – An Affiliate Of USCF Health, Updated 3-2014

2. Talking With Your Doctor About Prognosis

Understanding Statistics Used to Guide Prognosis and Evaluate Treatment word

Critical appraisal of Prognostic studies: Are the results of the study valid? (Internal Validity) from CEBM – Centre for Evidence-Based Medicine of The University of Oxford

Clarifying Diagnosis and Prognosis in Cancer: Guidance for Healthcare Providers

Cancer treatment decisions: 5 steps to help you decide

Care at the End of Life for Advanced Cancer Patients: When to stop cancer treatment

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