A team from Yale asked older people with serious illnesses how they envision their futures: “Will die suddenly. Will dies with a day or two of serious complication. Will die after prolonged illness. I don’t know.” Roughly 40% responded “I don’t know,” and one-third said they expected a prolonged illness. Patient responses appeared uninfluenced by age, race, depression, fatigue or pain. The patients in the study all had terminal illnesses with a somewhat predictable trajectory, yet, patients were still uncertain. Did the patient avoid asking? Did the doctor not share? Was it explained, but patients failed evaluate the information? The explanation could be the erroneous assumption that death occurs instantly, or within a couple of days, suggesting patients felt no need to discuss the end of life.

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