# Prognostic Evaluation Tools to Facilitate Advance Care Planning in Two Older Patients With Terminal Cancer: A Report of Two Cases

## TL;DR

This paper discusses how prognostic tools helped two terminal cancer patients and their families make informed end-of-life care decisions.

## Contribution

The paper demonstrates the practical use of prognostic tools in facilitating advance care planning for terminal cancer patients.

## Key findings

- Prognostic tools like PaP and PPI supported a patient's decision to avoid intensive treatment and pass away at home.
- Prognostic tools helped a reluctant family accept the patient's advance care plan after discussions.
- Objective prognostic tools are valuable in clinical decisions for terminal cancer patients.

## Abstract

Palliative prognostic index (PPI) is developed and utilized to assess the prognosis of terminally ill patients. Understanding the life expectancy is critically important for patients and their families. We present two terminally ill cases due to cancer in which we used prognostic evaluation tools during advance care planning (ACP) among patients, families, and medical staff. In the first case, the patient and her family initiated an ACP early in her diagnosis. The unfavorable prognoses indicated by PaP and PPI supported and reaffirmed their decision for no intensive treatment or life support, allowing her to pass away peacefully at home. The second case involves a family initially reluctant to accept the patient's ACP, which refused intensive therapy or life support for malignant tumors. However, the family understood and accepted the patient’s initial ACP through careful discussions utilizing these prognostic tools. These cases highlight the importance of using objective prognostic prediction tools to support clinical judgments, particularly in the terminal stages of malignant tumors.