**6. Conclusions**

Prognostication is an evolving science. As newer therapeutics extend and improve the expectations of critical illness management, transparency and accuracy are key factors of value to patients. For clinicians, continuing education in communication and routinely rehearsing difficult conversations may promote easier and more transparent conversations. Utilization of prognostic tools in combination with clinician prediction and interdisciplinary consensus improves overall accuracy in uncertain circumstances. Prognostic discussions should be viewed by the clinician and patient as fluid. Routinely re-evaluating and modifying prognostic estimates based on current individual circumstances, changing health status, and therapeutic advances are critical to support patient centered decision making.
