Issues in prognostication for hospital specialist palliative care doctors and nurses : a qualitative inquiry

We have known for some time that patients who live with advanced life-limiting diseases have high information needs about their prognosis, unfortunately conversations about prognosis between patients and health care professionals are either avoided or are inaccurate in their content due to over optimism on the health professionals' part. There has a lot of work carried out developing aids to prognostication and although prognostic models are generally available they are problematic because they ultimately rely on professional opinion/intuition so people don't see the point of using them. The literature indicates that hospital specialist palliative care professionals are frequently asked to prognosticate, but their everyday experience of prognostication is unknown and not documented in the literatire. This raises a number of questions, 'How do specialist palliative care team members prognosticate?' and, 'How do they view prognostication?' This conference presentation reports on a qualitative research project using focus group interviews with 3 UK hospital specialist palliative care teams to explore these issues. The focus group interviews were transcribed and analysed using Woolacott's framework. From the analysis 2 major themes emerged - Difficulties of prognostication; and benefits of prognostication; and 11 eleven sub-themes were also identified (Difficulties - Non-malignant disease, Communicating uncertainty, Seeking definitive prognosis, Participants' feelings, Confidence in prognostication, Estimating prognosis, Dealing with reaction of prognosis, Prognostic error; Benefits - Patient-informed decision making prioritising needs and care, Family-prioritising commitments, Services accessing funding and services planning patient care). Our findings highlight that there is a lack of evidence to support current palliative care practice around prognostication and little that acknowledges the complexity and emotional labour involved in prognostication by hospital specialist palliative care team members. We discuss recommendations for further research and practice.