Inaccurate Predictions of Life Expectancy

Predictions regarding life expectancy are often imprecise, a problem in determining eligibility for hospice care, and further evidence is presented of this lack of accurate prognostication.

Abstract

Hospice is a successful model for providing palliative care and psychosocial support to terminally ill patients. Although most patients who receive hospice care have cancer, patients with acquired immunodeficiency syndrome increasingly are taking advantage of these programs. Since 1983, Medicare has provided hospice reimbursement for patients meeting four criteria: (1) life expectancy of six months or less as certified by a physician; (2) unable to benefit from aggressive or curative therapy; (3) able to receive at least 80% of care at home; and (4) availability of an individual who can provide custodial care and serves as a "proxy" decision maker for health care decisions if the patient becomes mentally incapacitated.1 See also p 2540. Unfortunately, predictions regarding life expectancy are often imprecise, a problem in determining eligibility for hospice care. In this issue of theArchives, Forster and Lynn2present further evidence of this lack of accurate prognostication