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May 17, 2000

Prognostic Criteria for Hospice Eligibility—Reply

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;283(19):2527. doi:10.1001/jama.283.19.2521

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.

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