# How is time to death calculated in terminally I’ll patients?

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How is time to death calculated in terminally I’ll patients?

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Simple, how many days until the insurance runs out?

A lot of the time, it’s not even calculated. It’s just referenced. Let’s say there’s a form of terminal cancer that a million people have died from in modern medical history. It would be pretty well known how quickly the disease progresses at that point.

Inaccurately.

It’s a guess, based on how similar cases have ended. Over time, as you get more sick, the estimate might get smaller or more accurate, but ?t’s just an educated guess.

Usually just an educated guess by the doctors who from experience have seen so many they can give a good estimate based on the condition of the patient, the severity of their symptoms and the rate of decline.

Basically they compare it to lots of other patients with similar diseases.

To be honest docs tend to try to give a range, we rarely know that firmly for most things. Often you’ll say days vs weeks vs months vs years, rather than a set estimate. Some things are more predictable, but especially cancer often depends on where it spreads and what it does (eg lung cancer might kill someone earlier than expected if it causes lung collapse).

This is also why so many people have stories of “the doctors said I wouldn’t survive the night / walk again” etc. A good doctor isn’t going to say that your relative is going to live if there’s a 50/50 they die. They’re going to prepare you for the worst, because pretty much noone is going to be mad if someone unexpectedly survives, but if family feels unprepared, or that they had a lot of false hope…

Do you mean the prediction of how long someone likely has left? Or do you mean when someone who was terminally ill is found dead in bed, how do they work out the time to put on the certificate, rather than saying at some point between x and y time?

It’s really: on average 95% of people with your condition live 6-9 months from here.

That means some live more, some live less. And then there is 5% who are well outside that confidence interval

Kinda how you find the slope of a line, point a and point b, you find the rate of change. At two appointments they examine to find progress, and given the point at which death *usually* occurs, they can estimate when that will be based on current spread.

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It isn’t. You go by the current condition (respiration pattern, urinary output, blood pressure, color of extremities, etc.) and by experience you guess. That is the best you can do. I took care of a patient that seemed stable and was asked how long and my guess was days to a week. She died that hour. Another patient that was in a Cheyenne stokes respiratory pattern that was nearly agonal with almost no output went over a week until demise….the family even asked if I would routinely administer sedatives and narcotics to hasten death….of which I refused. I will gladly try to control pain and discomfort but by my oath to my profession I will not try to hasten death artificially.

Usually it’s from experience. Doc’s have seen a lot of death and they know the physical condition of the patient. It’s usually enough to give a window. That being said, people can defy expectations on both ends.

Further, medical science being what it is, people have a lot more input into when they die than ever before. Usually in the form of discussions with families and medical professionals. People decide how much technology they want used to keep them alive and what’s too much. Often, medical science can keep a body ‘alive’ nearly indefinitely so it’s critical that people decide how far they’re willing to go before it’s too late and you lose capacity, because if you don’t decide then healthcare will default to extraordinary measures to keep you alive until someone steps in to stop it …and that’s a burden that you don’t want to push on to your loved ones. There’s a truism in healthcare that death is not always the worst outcome…

Finally, when I worked in surgical units, we had zero people die in surgery. It simply wasn’t allowed to happen. Instead, if someone wasn’t going to make it after every option was exhausted, they were transferred to intensive care and kept alive long enough for families to come say goodbye.

We guess.

We see a lot of people die so we can form estimates based on how long other people held on when they were at a similar stage.

For example, if someone near death stops eating, they likely have less than 2 weeks to live. If their skin is starting to mottle and they’re agonal breathing, then hours to days.

However, I’ve personally been wrong so many times that I’ve learned to not give direct estimates. I tell the patient “hours-to-days”, “days to weeks”, or “weeks to months” based on the stage of their disease and other signs they’re showing.

If you’re talking about the prognosis when someone has cancer and the doctor “gives them six months”, that’s a calculation called the median survival tjme. It’s based on how long other patients with this cancer have survived past diagnosis.

If the median survival time is six months for a particular kind of cancer, that means that half the patients survived more than six months after they were diagnosed, and the other half died before six months.

There’s a great essay by Stephen Jay Gould called “[The Median Isn’t the Message](https://journalofethics.ama-assn.org/article/median-isnt-message/2013-01)”, about how he could have been terrified by his cancer diagnosis with its short median survival time except that he knew how to interpret statistics and understood that some of those patients lived *far* beyond the eight months that was quoted. He did ultimately survive a couple of decades beyond his diagnosis, if I remember correctly.

Being a doctor, I can confidently say that no doctor in the world will be able to tell when a patient is going to die accurately.
I’ll never give deadlines to patients. Patients whom i thought will die in a day have lived longer than a year and vice-versa. But I am able say if a patient is going to die in the final hours(~4-5hrs)….once they hit the point of no recovery I have never seen a patient coming back …

This is actually a very up and coming area of artificial intelligence and machine learning. Doctors use various metrics, along with personal experience, but algorithms are being developed that can look at hundreds of different variables, include genetics, family history, medical tests, rates of change, etc… to improve accuracy.

Statistics. If you’re thinking its like an ongoing estimate you’re mistaken. Its a one time thing when someone gets diagnosed, its just the average life span with that diagnosis if it is terminal, and the odds of beating it if it isn’t.

Definitely time travel!

They travel forward and check the death records!!

5 yo’s will believe anything¿¿?!

Seriously I’d say they just guess based.in experience of other patients and only give a range.

From what perspective are you asking?

There’s a a group of statistical methods broadly known as survival analysis or time-to-event that are used to, amongst other things, determine the survival (or time to death) of terminally ill patients. Obviously it depends on several factors and can only be expressed in terms of estimates for the population based on observed data (true of all research) so you can never be certain of time to death in an individual. As others have noted, you might be able to say something like, for a female with stage 3 breast cancer of your age, 50% of people live longer than X years. But you could never say to someone, you will die in 3 months. Obviously the closer a person gets to death from a terminal illness, the more obvious it becomes and you can be more certain.

From another perspective, as others have noted, doctors have experience with various illnesses and can make general statements about how long a person might expect to live. But they won’t (shouldn’t) give very precise estimates because it’s very easy to be wrong. You don’t have to look very hard to find examples of people being told they only had months to live and are still kicking around years later. Unfortunately the opposite can also be true (die much sooner than expected).

We don’t give people “x months to live”. It generally ends up being inaccurate and creates a lot of confusion and stress.

I can tell you when you or your family will die in minutes or hours and am reasonably accurate for a few days. All of that is really just an eyeball guess based on objective data and the natural course of whatever disease the patient has.

For longer term diseases, there are various mortality calculators and data to guess when someone will die, but it’s not really a guess. All we know is that “‘x’% of people die in ‘y’ years”. We often don’t know how well or poorly someone will do because the data is not that individualized.

Sadly, we are typically terrible at prognostication for time horizons any longer than what I mentioned above. People die earlier and later than we think.

Source: I’m an IM doctor.

Edit: a few sentences changed for clarity

I tried to get a doctor to tell me when grandpa would die, was trying to get week, month, day out of him (not imfeont of grandpa so siblings, etc could come say goodbye) & he shook his head and said. Soon but the exact date is impossible to know. If they tell you hospice than usually a month or so & the hospice people know when it is going to happen. They said within “24hrs” and they were right.