When you find out that you or someone close to you is sick, the next big question that comes to mind is "What happens now?" "Will this get better?" "Will I ever be able to live like I used to?" That's when doctors talk about a 'prognosis'. Okay, let's see what this is, in simple terms.
What exactly is 'Prognosis'?
Simply put, a 'prognosis' is a prediction your doctor makes about your illness, that is, your condition, using medical knowledge and experience. It's like a weather forecast. But it's more complicated than that, because everyone's body and how they respond to illness are different.
Imagine, the doctor tells you that you have a certain disease. A lot of questions suddenly arise in your mind, don't they?
- "Can this be cured?"
- "Will I be able to recover completely?"
- "Will the symptoms of this disease subside?"
- "Will I be able to stay where I can do my work alone?"
- "Is this treatment worth it?"
- "How much longer can I live?"
For questions like these, the doctor can tell you what is most likely to happen to you, based on the experiences of others. That is the 'prognosis'. It is not a 100% accurate prediction, but it is the best guess based on the information currently available.
So, why is it important to know this 'prognosis'?
Knowing this gives you and your caregivers a lot of strength. It helps you make decisions with your best interests in mind. We can't always stop ourselves from getting sick or having accidents. But knowing the 'prognosis' gives us some understanding to cope with things we can't control.
Make decisions about treatment
Knowing your prognosis can help you choose treatment, or even refuse it. Treatment decisions are not easy. Think about it, someone might be willing to undergo a treatment that has serious side effects, if it could prolong their life a little. But someone with the same diagnosis might refuse that treatment. They might think, "It's better to live a few days without pain, even if it means living a happy life."
Also, some care services are based on the prognosis. For example, if you know that your symptoms are likely to get worse, you may be able to find services such as palliative care, which helps control pain and provide psychological relief. In some countries, services such as hospice care are available to people who are expected to live for about six months. In such cases, the prognosis opens the door to resources that can help you live comfortably at the end of your life.
Make other decisions in life.
Understanding your prognosis can help you plan your day. It can help you get your finances and spiritual life in order. It can help you think about who you need to talk to and what important things you want to achieve in life. It can also reduce the pressure to make big life decisions quickly, knowing that you have a chance of making a full recovery.
How do doctors determine this 'prognosis'?
Most doctors base their 'prognosis' (plural 'prognoses') on medical research and their own experience. Your doctor may look at medical statistics. Researchers study the experiences of large groups of people and look for patterns in disease. Knowing what happened to the majority of people with a particular disease in the past is useful for predicting what might happen to a particular person.
By combining a person's clinical condition, as well as data from others with the condition, doctors can create a 'prognosis' tailored to each individual.
Here are some statistics your doctor may consider:
- Survival rates: How many people with a certain diagnosis are alive after a certain period of time. For example, cancer researchers look at how many people with a certain diagnosis of cancer are alive after five years.
- Complication rates: This measures how many people develop additional health problems, either during the course of a disease or after a certain treatment. These things can change your prognosis.
- Treatment success rates: This measures how well a treatment helps achieve a specific outcome for a disease (e.g., curing the disease, reducing the spread of the disease, reducing symptoms).
- Recurrence rates: This refers to the chance that a disease or symptom will come back after it has gone away. This often refers to the chance that a cancer will come back after a period of 'remission' (the absence of signs or symptoms of the cancer).
What are the prognostic factors?
Doctors also look at specific factors that can affect the severity of a disease. Some of these are specific to cancer, but many are common to many other conditions.
- Type of disease: The specific type of disease affects the prognosis. For example, the type of cancer (i.e. where in the body it started) affects your future outlook.
- The extent of the disease: How far the disease has spread is an important factor to consider when making a diagnosis. For example, in some cancers, the stage of the cancer (i.e. how far it has spread) is a major factor in determining the cancer's prognosis.
- Biological and genetic characteristics of the disease: The type of genetic mutations in a cancer cell and how abnormal the cells are can give an idea of how "aggressive" (i.e., likely to spread) the cancer is.
- Your overall health: Having more than one health condition (`comorbidities`) can often worsen the prognosis.
- Whether or not there are effective treatments: Access to effective treatments improves the 'prognosis'.
- How you respond to treatment: In general, if you get better after treatment, the prognosis is good.
- Your activity level: How active you are throughout the day, and whether you can perform daily tasks like getting to your workplace and getting dressed, can give clues about your future status.
- Demographic factors: Sometimes things like age, gender, race, and ethnicity can be associated with how a disease typically progresses.
The factors that are most important to your prognosis will vary depending on your condition. You can ask your doctor what factors he or she considers when determining your prognosis.
Prognosis calculators
Some doctors use special "calculators" to help determine a person's prognosis. First, they enter "prognostic" factors (e.g., age, health conditions, activity level) into the calculator. Then, the calculator uses a formula that calculates "prognostic" information, such as life expectancy. While these are not 100% accurate, they can give you a general idea of a person's prognosis.
How do doctors talk about 'prognosis'?
Sometimes doctors describe 'prognosis' in one level:
- Very good (Excellent)
- Good
- Fair
- Poor
"Guarded prognosis" means that there is not yet enough information to make an opinion about the future outcome.
When you hear about the 'prognosis' in this way, you can start to talk about the details. For example, when you hear that the 'prognosis' is "poor", it helps you mentally prepare to talk about the difficult decisions you have to make.
However, there is no single way that doctors share information about 'prognosis'. For example, your doctor might talk about your 'prognosis' like this:
- As a range: For example, a doctor explaining how long you have to live might consider survival statistics and your 'prognostic' factors. Based on this information, he or she might say that you have about three to five years to live.
- Best and worst case scenarios: Some people like to be mentally prepared for both the best and worst that can happen. For example, the best case scenario is that you will live for about six months after treatment without any side effects. The worst case scenario is that complications from the treatment shorten your life.
- As a most likely outcome: Your doctor may describe the most likely outcome. For example, the most likely outcome is that after treatment, you will have about three months to live with some side effects that can be controlled with medication.
The most important thing: Remember that no matter what your doctor says, no one can predict your future. Also, your doctor may change the 'prognosis' as new information becomes available, such as how you respond to treatment. 'Prognosis' is something that can always change.
Is the 'prognosis' really accurate?
To a large extent, yes. Most doctors have reliable information that can make informed predictions about the future course of your disease. Studies have shown that the most accurate 'prognosis' depends on a combination of both data (e.g., 'prognostic' calculators) and your doctor's medical judgment. Speaking of accuracy, some studies show:
- It is easier to predict the short-term outlook accurately than the long-term outlook.
- 'Prognostic' tools that look at things like your activity level are likely to be more accurate than tools that look at things like your age or gender.
But, in addition to asking if it's accurate, you also need to ask if this information is useful. For example, your doctor may suggest a treatment that could extend your life by a few months. But if that treatment has a high risk of complications, and your main goal is to live out your remaining days without complications, that information is not very useful. A doctor may say that your cancer is incurable. But if all you care about is whether you'll live long enough to attend your child's graduation, that information is not very useful.
To be honest, your doctor may not be able to answer all your questions. But the more he or she knows about your concerns and what's important to you, the easier it will be for him or her to explain things.
How do I talk to my doctor about 'prognosis'?
When you receive a diagnosis, you may feel very powerless. It may seem like the doctor has all the information and all the power. But remember, when it comes to 'prognosis', you have power too. In reality, the most important information – what is important to you – is with you.
When discussing prognosis with your doctor, you can do the following:
- Tell them what your main concerns are: It may take some time to figure out what is most important to you regarding your prognosis. For some, it may be living a little longer. For others, it may be doing their daily activities as normally as possible. For others, it may be living without pain or other symptoms. Once you have identified your main concerns, share them with your doctor.
- Tell him how much you can listen: You may not be in a good place mentally to know every detail of a bad 'prognosis'. Tell your doctor how you're feeling. If you'd rather talk about the outcome in general terms, say so. If you want to ask for details (even if they're difficult), don't be afraid to say so.
- Tell him how you prefer to get information: Some people want to know the best and worst-case scenarios. Others only want what is most likely to happen. Some people like to know the medical statistics that doctors use to determine their 'prognosis'. Others are afraid of that data. Ask for what you want, what you can handle.
- If you don't understand something, say so: Sometimes doctors forget that not everyone understands things like ranges and percentages. There's nothing wrong with asking your doctor to take it slow and explain things you don't understand.
What is the difference between 'Prognosis' and 'Diagnosis'?
A 'diagnosis' is the medical condition that a doctor finds out you have after conducting tests. A 'prognosis' is the expected outcome of your 'diagnosis'. A 'prognosis' looks at things like whether you are likely to recover and what your condition is likely to be like . Think of 'diagnosis' (d) as (d)iscovery - a discovery, and 'prognosis' (p) as (p)rediction - a prediction of what is likely to happen.
Are 'prognosis' and survival rate the same thing?
'Prognosis' and survival rates are not the same thing, but they are related. Doctors often look at survival rates to determine a specific part of 'prognosis': how long a person is likely to live. Survival rates are one of the most important pieces of information that doctors use to determine a person's 'prognosis'.
Finally, things to remember (Take-Home Message)
Many of us who receive a new diagnosis want to know exactly what will happen next. Unfortunately, medical statistics are not good enough to predict the future. However, knowing your prognosis is the next best thing. Your prognosis can give you more confidence in your treatment choices and decisions about how you spend your time.
Don't be afraid to ask your doctor questions about your 'prognosis'. There's nothing wrong with asking for clarification. It's also a good idea to focus the conversation on the questions that are most important to you regarding your future health. Remember, knowledge is power!
` Prognosis, diagnosis, recovery expectations, medical advice, treatment decisions, life decisions, health information
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