Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
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.
Fox GN. Communicating Life Expectancy to Patients With Terminal IllnessCommunicating Life Expectancy to Patients With Terminal Illness. JAMA. 2003;290(15):1995. doi:10.1001/jama.290.15.1995-a
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