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When patients and doctors disagree about prognosis

As palliative care physicians who frequently discuss goals of care with seriously ill patients and their families, we often get called because the patient/family is “in denial.” In a common scenario, we are consulted by a medical team where team members want us to make sure the family “gets it” and them makes the “appropriate” decision for a do not resuscitate (DNR) order or for hospice care. Too often, from the consulting service perspective, the term “denial” is a substitute for “the patient won’t do what we think they should be doing.” In these cases, our first challenge as clinicians is to understand the patient beliefs that underlie the disagreement, including how the patient obtained them, how those beliefs function in their life and family, and their malleability.