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October 15, 2003

Communicating Life Expectancy to Patients With Terminal IllnessCommunicating Life Expectancy to Patients With Terminal Illness

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(15):1995. doi:10.1001/jama.290.15.1995-a

To the Editor: In their Perspectives on Care at the Close of Life article, Drs Lamont and Christakis1 discussed the complexities of delivering prognostic information to patients with terminal illnesses. There is one addition that I find particularly helpful in dealing with these situations. I explain to patients that there are different types of "averages." In the case in cancer survival, where numbers vary widely and in a nonnormal way, I explain that statisticians use a different type of measure, the median, and then explain that half of patients can be expected to live longer than this time, while the other half will not. Initially, I related this information to provide patients hope about surviving longer than the stated prognosis while still being completely truthful. However, after having patients die much sooner than expert prognostications had predicted, relatives have told to me that, had we not had that specific discussion about the meaning of the median survival, they would have been quite upset by the unanticipated rapidity of death.