Table 1.

The 5 Ps of Discussing a Poor Prognosis

The 5 Ps	Description	Sample Questions
Perspective	Explore patient’s and families’ perspective on life-limiting illness	“Tell me more about what you think is going on right now.” “You asked if I thought you were dying. Is that how it feels to you?” “Tell me more about that.”
Prior experiences/context	Prior experiences with life-limiting illness (personal, family member, friend)	“Have you had anyone close to you go through something like this before? What do you remember about that experience?”
Permission	Permission to share information about prognosis	“Is it all right with you if we talk more specifically about your prognosis?” “I’m afraid I have some bad news – is it ok if I share it with you now?”
Prognosis	Utilize best practices for expressing prognosis; balance truth-telling and hope	“What we know now is that your cancer is something we can’t fix. And – as you’ve had more and more complications, it’s become clearer to me that your body probably won’t be able to recover from this.” “If we had 100 people in your situation, I think about 1 in 100 might recover enough to leave the hospital and go to a nursing facility, which means that 99 in 100 would die from their illness.”
Provision of support	Support emotion; explicitly communicate statements of non-abandonment; discuss next steps; reframe hope	“I wish that things were different.” “I can see that you’re sad.” “I want you to know that, no matter what happens, we are committed to caring for you.” “Even though we may not have medicine to fix your kidney disease, we have so many things that we can do to care for you – to help with your nausea, your pain, and the anxiety you’re feeling.”