In the current health care climate a large portion of health care dollars are spent in the final months of life, so ensuring that care provided is in line with the wishes of patients and their families is more critical than ever. On the one hand, surviving families often report that they wish they had been given prognostic information earlier and that, in retrospect, they would have made different treatment decisions if they had been given prognostic information. On the other hand, providers often are reluctant to discuss prognosis for various reasons, not the least of which is the inherently uncertain nature of prognostication. To address this issue, this article reviews pertinent literature about provider reticence, family preference, and the move toward palliative care and includes a discussion of the various validated mortality-prediction models available. A case is made to use those validated metrics to guide early discussions of palliative or end-of-life care for patients who are critically ill. A suggested checklist to facilitate inclusion of prognosis discussions in family meetings is included as well as a case study to illustrate the problem, current practice, and a model for improvement.

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