Jan 23, 2019

How do doctors assess how long someone will live?

When we hear that someone has been diagnosed with a terminal illness, we are also often given a stark timeline.

“Doctors say he’s only expected to live six months,” someone might say.

So, how do doctors come up with these life expectancies, and how accurate are they?

After all, we’ve all heard the stories of someone being given only 12 months to live, and a decade later they’re fully recovered and going strong.

It’s difficult to accurately estimate life expectancy

Dr Jane Fisher, Board Chair Palliative Care Australia and CEO/Medical Director of Calvary Health Care Bethlehem, told HelloCare there is research showing how bad doctors are at predicting how long someone will live.

Life expectancies are calculated “with difficulty”, she said.

When someone is told they have an incurable disease, it’s understandable that both the patient and their friends and family will want to be given some idea of how long their loved one is expected to live, and so providing an estimate of life expectancy is something doctors often do – even if they can only do so with uncertain accuracy.

‘Prognostication’, the medical term for estimating someone’s life expectancy, takes a number of factors into consideration.

Dr Fisher said she considers what the disease is, and the rate it’s progressing. She looks at other factors impacting the health of the patient, and also notes the rate of change in the patient’s condition.

“Rather than just looking at scans and test results, I often look at the person and watch their rate of change,” she said.

“Some people can be doing well, and then all of a sudden there is a dramatic change in how much they’re eating, and how much they can do,” she said.

This change could signify the end of life is nearer than might otherwise have been expected.

Caring for someone at the end of life: hospice vs. palliative care?

What sort of care is available for people at the end of their life?

A hospice is a place that people go to to die, and where people can receive palliative care. Hospices aren’t common in Australia, although they are common overseas, particularly in the UK.

Palliative care is a holistic approach to caring for someone who has an incurable disease. It has physical, emotional, spiritual and social aspects, and also takes into account helping the family prepare for the death of a loved one.

Palliative care usually means keeping a patient with an incurable disease as comfortable as possible in the final weeks of their life.

Palliative Care Australia lists the main palliative care services as:

  • Pain relief
  • Relief from other symptoms such as vomiting or shortness of breath
  • Help for families to talk through sensitive issues
  • Help for families to find help at home and financial support
  • Help meeting cultural obligations
  • Emotional, social and spiritual support
  • Counselling
  • Referrals to respite care

Dr Fisher said ideally every Australian should have access to palliative care in their place of choice, whether that be in a nursing home, a hospice, or at home.

“They can have good basic palliative care at an aged care facility or at home,” she said.

However, Dr Fisher acknowledged that unfortunately those in remote and low socio-economic areas often don’t have access to the palliative care services you would hope for.

Most palliative care costs are covered by Medicare.

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  1. So very true, was a nurse for over forty years until recently, family members do always ask. I was diagnosed with a brain Tumour in 1993, my neurosurgeon stated recently that what ever I’ve been doing for the last twenty years or so, to keep doing it as no one in neuro intensive care ever thought I would live. As a nurse when they are palliative it does become clearer to some of us that they are going to go tonight. I ended up having two lots of microsurgery and two years later got another, had six weeks radiation.

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