How tracking a patient's personal rate of decline can sharpen prognosis

Predicting decline, not just death

Prognosis is about more than estimating a timeline — it shapes everyday clinical decisions, from whether to continue medications to recommending surgery, dialysis, or hospice care. Speaking at OMED in Las Vegas, palliative care physician Dr. Leonard Hock emphasized that clinicians often struggle with prognostication because of an inherent optimism bias, which can erode patient and family trust when expectations don't match reality.

Dr. Hock highlighted that a patient's personal rate of decline — how quickly their health and function deteriorate compared to their own previous baseline — is the strongest prognostic indicator available. Combined with structured tools and honest conversations, it can meaningfully improve care planning.

Key Takeaways:

• Tools like the Palliative Performance Scale, ECOG performance status, CARING criteria, and lab values (e.g., albumin) can support prognostic assessments
• The "surprise question" ("Would you be surprised if this patient died in the next 6 months?") is a useful prompt for both clinicians and families
• Signs of dying shift across timeframes: months (fatigue, reduced appetite), weeks (increased sleep, weight loss), days (dependence on ADLs), and hours (dysphagia, wet breathing, unarousability)

Why it matters: Accurate prognosis empowers patients and families to make informed, values-aligned care decisions — and helps clinicians avoid over- or under-treating at the end of life.