Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Contributing EditorIndividualAuthor
In Reply: We agree with Mr Simpson that prognostic
guidelines cannot accurately identify patients who will die within 6 months.
We disagree, however, with his suggestion that "the guidelines require further
development for them to achieve prognostic confidence and accuracy." To the
contrary, as we stated in our article, "the goal of determining in advance—with
a high degree of accuracy—which individual patients with COPD, CHF,
or ESLD will die within 6 months is unrealistic." These patients typically
die as a result of sudden, unpredictable events. Thus, policy should not assume
that precision in prognosis is possible. Instead, eligibility for comprehensive
end-of-life care should be based on severity of illness, and modified by patient
preferences and service needs.
Fox E, Lynn J. Prognostic Criteria for Hospice Eligibility—Reply. JAMA. 2000;283(19):2527. doi:10.1001/jama.283.19.2521