A prognosis is a prediction of the probable course and outcome of a disease or the likelihood of recovery from a disease. Seriously ill people and their family members are entitled to the most complete information available and the most realistic prognosis possible. A prognosis can provide a likely trajectory of decline and can help estimate when death will occur but cannot provide a precise timeframe. Health care professional sometimes estimate a range of time in which a person is likely to die. A range might be needed, for example, to order hospice care, which usually requires a doctor’s prognosis of less than 6 months to live.
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Symptoms progress differently with different diseases. For example, in some people dying of cancer, energy, function, and comfort usually decrease substantially only in the last month or two before death. During this time, the person is visibly failing, and the fact that death is near becomes obvious to all. Other diseases, such as Alzheimer disease, liver failure, and kidney failure, may follow a more gradual decline from the beginning but sometimes at a rate that is unpredictable. Severe heart disease and chronic obstructive pulmonary disease cause a steady decline but with episodes of serious worsening. These episodes are often followed by improvement, but usually death comes after an episode or worsening that develops within a few days of being stable. Sometimes very sick people live a few months or years, well past what seems possible. Other people die more quickly than anticipated.
Communicating with a dying person
Many people find it difficult to discuss death openly with a dying person. However, people living with eventually fatal conditions usually do better when family members continue to speak with them and include them in decision making. The following suggestions can help people feel more comfortable when communicating with a dying person:
Listen to what the person is saying. Ask, for example, “What are you thinking?” rather than shutting down communication with such comments as “Don’t talk that way.”
Talk about what the person would envision for surviving family members at a time long after death has occurred and work back toward events nearer to death. This allows for a gentle introduction to a discussion of more immediate concerns, such as the person’s preferences regarding funeral arrangements and support for loved ones.
Reminisce with the dying person because this is a way of honoring the person’s life.
Continue to speak with the dying person, even if the person is unable to speak. Other ways of communicating, such as holding the person’s hand, giving the person a massage, or just being near the person, can be very comforting.
