title: Conveying uncertainty in prognosis to patients with ESRD.
abstract: BACKGROUND
  Prognosis is a component of medical practice imbued with uncertainty. In nephrology, where mortality rates of elderly patients on dialysis are comparable to those of cancer patients, the implications of prognosis are unavoidable. Yet while most patients with end-stage renal disease (ESRD) desire to hear their prognosis, many nephrologists balk at this prospect in part owing to the uncertainty inherent in prognostic estimates.
  
  
  CONCLUSIONS
  In this review, the concept of 'uncertainty' in clinical practice is considered from physician and patient perspectives. From the training perspective, providers learn that uncertainty is inescapable in medicine and develop strategies to manage its presence, including the avoidance of communicating uncertainty to their patients. This presages infrequent discussions of prognosis, which in turn influence patient preferences for treatments that have little therapeutic benefits. A general approach to conveying prognostic uncertainty to ESRD patients includes confronting our own emotional reaction to uncertainty, learning how to effectively communicate uncertainty to our patients, and using an effective interdisciplinary team approach to demonstrate an ongoing commitment to our patients despite the presence of prognostic uncertainty.
  
  
  CONCLUSIONS
  Uncertainty in prognosis is inevitable. Once providers learn to incorporate it into their discussions of prognosis and collaborate with their ESRD patients, such discussions can foster trust and reduce anxiety for both sides.
authors: Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, N.Mex., USA.
authors: Sanah
authors: S
authors: Parvez
authors: Khaled
authors: K
authors: Abdel-Kader
authors: Mi-Kyung
authors: MK
authors: Song
authors: Mark
authors: M
authors: Unruh
mesh_terms: D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D010361:Patients / Q000523:psychology*; D010817:Physician-Patient Relations / Q000941:ethics*; D010820:Physicians / Q000523:psychology*; D011379:Prognosis; D006435:Renal Dialysis; D016019:Survival Analysis; D035501:Uncertainty