Introduction: Prognosis is an issue which most doctors and patients find difficult to discuss. Both patients and physicians find this process distressing as they can be unprepared to receive and give life-altering news. Although clinicians report that they are discussing prognosis, patients and caregivers frequently do not corroborate these reports, creating communication gaps especially in end-of-life situations. Objective: This study determined how attending physicians documented the communication of prognosis on the patients’ records in terms of content, timing, and frequency during the course of hospitalization. Methods: This is a retrospective chart review of 234 terminally-ill patients admitted from January 2020 to March 2020 in five (5) clinical departments of a public tertiary hospital. Discharge summaries and physicians’ daily chart notes were reviewed to identify the major events of each case. Results: Two-thirds of the patients’ records had no documentation of any discussion with patient/family/significant others relating to patients’ worsening condition. The quantitative and qualitative forms of contextual information regarding patient prognosis were infrequently recorded. Notes on conversations of survival rate, probability of treatment response and failure were likewise lacking. However, for the occasional documentation observed, the timing of the communications was appropriate across the disease trajectory and was significantly correlated with all major points of illness deterioration (p<.001). Physician and patient characteristics had no association with the practice of documenting communication prognosis Conclusion Communication prognosis is not a common practice for most physicians. Prognosis was poorly documented on the patients’ charts, which could suggest that either such a communication process did not take place at all or physician education on documentation should be reinforced by an institutional protocol, especially in the care of terminally ill patients.
Terminal illness ; prognosis

No abstract available.
Critical Illness ; Decision Making ; Humans ; Life Support Care ; Quality of Life ; Terminal Care ; Physician-Patient Relations ; Withholding Treatment

Hospice and palliative care can help terminal patients and their family members to face the natural end of life more comfortably, by providing them with an environment to address psychosocial and spiritual problems, as well as physical symptoms. However, most patients and their caregivers have the misconception that hospice care means the withdrawal of all treatments. Many physicians also consider hospice care to be a form of terminal care after all treatments are finished. Laws regulating the withdrawal of life-prolonging treatment came into effect in Korea in 2018, and these regulations also apply to most terminal stages of benign diseases. The withdrawal of futile life-prolonging treatment is quite different from euthanasia or negligence. At the last stage of disease, treatment aimed at alleviating various symptoms can make critically ill patients more comfortable and thereby help them to die with dignity. Patients with a terminal illness should receive hospice and palliative care, instead of futile life-prolonging treatment. Therefore, education and training programs to promote a proper understanding of hospice and palliative care should be considered mandatory.
Caregivers ; Critical Illness ; Education ; Euthanasia ; Hospice Care ; Hospices ; Humans ; Jurisprudence ; Korea ; Malpractice ; Palliative Care ; Social Control, Formal ; Terminal Care ; Withholding Treatment