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The syndrome of ‘prognostic paralysis’ has been described in general practice settings as a feeling of being unable to act due to being very uncertain about the likely course of a patient’s illness. 1 This can be frustrating for patients and doctors alike and delay planning and treatment. However, three main illness trajectories of decline from progressive illness have been described from empirical research in the UK and USA in the last 20 years. These trajectories are (1) rapid decline (typically progressive cancer), (2) intermittent decline (typically with organ function) or (3) gradual decline from a low baseline (typically in older age, advanced neurological disease or dementia).2 3 In 2017 we noted that these three trajectories of declining physical health each have distinct and typical patterns of social, psychological and existential needs as the illness progresses.4