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