How is time to death calculated in terminally I’ll patients?
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It is an educated guess, and can frequently be way off. You’ve probably heard a story like “the doctors gave her three months to live, and she is doing great 5 years later!”. That said, in many terminal cases you can make a fairly good guess, especially days/hours before death. If your organs are shutting down, there is only so long you can survive.
Doctors listen for the end of life music that only they and the patient can hear, consult the relevant sheet music, adjust for tempo, and give an approximation assuming an average amount of improvisation.
The median age for all people of the same general group with the same type of cancer in the same stage.
If you were diagnosed with Stage 4 Lung Cancer, it would start with a list of all survival times for people with Stage 4 Lung Cancer, filtered to the same gender and potentially other factors and then sorted in from most to least. The number in the middle would be the life expectancy.
If using a range instead it would be a range that covers ~78% of people on the list centered around that middle point.
It’s a judgement call. We’re not lying when we say there’s no way to know for sure. We base it on our experience of how unwell the patient looks, how other patients have done in the same scenario and how fast things are changing.
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Often it’s whenever someone “official” witnesses it for the record. When my mom recently died of cancer, she was gone (and slightly cool to the touch), when my dad woke up at 7 am. So we know it was sometime before that. But then we had to call the hospice worker (she was doing hospice at home) and their medical staff came and made the official call. So her time of death is listed at around 8:30 am that day. All we really know it was sometime between 3 & 7 am.
I work in hospice and this is what I do: If a patient isn’t breathing I’ll use my stethoscope and blood pressure cuff to check for blood pressure, respirations, and a pulse. After 5 minutes of no pulse, respirations or blood pressure I look at my watch and That’s their time of death. That’s the time put on their death certificate.
If you have a good doctor, they won’t just tell you “4 months”. They might eventually say that’s their best guess, but that’s not actually a diagnosis.
What accurate science does is look at past patients with similar diagnosis, symptoms, etc., and then report survival rates for different timeframes.
e.g. “50% of patients with your diagnosis live for 5 years, 10% live for 10 years”
I don’t know what other places use, but for very end of life we use what is called a [Palliative Performance Scale](https://www.mypcnow.org/fast-fact/the-palliative-performance-scale-pps/).
It rates the current condition of the patient with past indicators of how long people in similar situations have lived.
Obviously people can float up and down the scale depending on the day and their condition but it lets us track how they are doing in their final days and when to decide to contact family.
We guess based on our experience. There are also studies that show median survival (time to death from diagnosis to when half the study population is dead) for specific groups such as patients with metastatic cancer.
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