title: Death is not the only healthcare outcome important to patients.
abstract: Unfortunately throughout history there have been wide variations in the way death has been handled by the medical profession in different times and places, and even today within the same hospital there are big difference between what doctors say they do and what actually happens. It is not currently possible to determine when severely ill patients become irreversibly unsalvageable and when attempts at resuscitation after death are futile. Without this knowledge it is impossible to honestly advise patients and their loved ones. There is little data available to show what proportions of patients are less sick or feel better on discharge from hospital than they were on admission and no robust systems for predicting such outcomes. Death is not the only healthcare outcome important to patients. Regaining or preserving health is the ultimate goal for patients, yet most hospital outcomes are reported only in terms of mortality. Developing models that predict a good clinical outcome may be more clinically useful than those that predict death. Patients are more likely to want to know their chances of getting better than their chances of dying. Also expressing treatment options in terms of its benefits (i.e. the chance of getting better) versus the risks (i.e. the chances the treatment will kill you) may be far more acceptable to patients than providing their risks versus the chance that they are going to die anyway.
authors.affiliation: Ballinaclough, Nenagh, County Tipperary, Ireland. Electronic address: jgkellett@eircom.net.
authors.forename: John
authors.initials: J
authors.lastname: Kellett
mesh_terms: D001291:Attitude of Health Personnel; D001293:Attitude to Death; D006801:Humans; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011788:Quality of Life; D020127:Recovery of Function; D013727:Terminal Care
keywords: End of life care; Healthcare outcomes; Healthcare value; Predictive scores; Prognostication