Researchers at the University of California, San Francisco (UCSF) have come up with new assessment tools to determine the likelihood of death within a certain period of time.
For this, they established a number of prognostic indices to predict the life expectancy in older and terminally ill patients. The main purpose of this project is to provide doctors, care givers as well as patients and their family members with information that can help prevent overtesting and overtreatment.
The UCSF team has also posted an interactive website online, called “ePrognosis.org,” which can be used to calculate a person’s mortality risk based on specific data, including age, health conditions, cognitive status, functional ability, etc.
“This is the first time such tools have been assembled for physicians in a single online location,” wrote Paula Span of the New York Times who reported on the project (1/11/2012) after a review was published in The Journal of the American Medical Association last week.
Among experts, responses have so far been mostly positive. “This kind of synthesis is very helpful for [health care] providers, researchers and some patients,” said Dr. Susan L. Mitchell, a geriatrician at Harvard University and researcher at Hebrew SeniorLife in Boston who was quoted in the Times article.
“A more frank discussion of prognosis in the elderly is sorely needed,” said Dr. Sei Lee, a geriatrician at UCSF and one of the authors of the review. A more accurate assessment of a patient’s life expectancy could help doctors and families evaluate, for example, whether an older person with a terminal disease should continue receiving treatments that may cause more pain and discomfort than relief, according to Dr. Lee. It may also be useful in determining how vigilant a patient has to be in observing and maintaining certain treatment- and lifestyle measures.
Since no calculation of life expectancy – other than based on data collected by U.S. Census Bureau – has so far existed, there is now hope that relatively easily accessible assessment tools like ePrognosis will be able to better assist health care providers with their decision making process.
In fact, many clinical decisions for older and terminally ill patients include considerations of life expectancy. But “at present, physicians are often shooting in the dark when they recommend tests, treatments and medications for older patients. […] Even when interventions do work, the benefits can be years away. Doctors have no easy way to know whether their elderly patients will live long enough to experience them. The potential for complications and side effects, however, is immediate,” wrote Ms. Span.
While it is true that with declining life expectancy some treatments may do more harm than good, it is not altogether clear whether accurate predictions can ever be made for an individual patient, cautioned Dr. Kenneth Covinsky, professor at the Department of Medicine, Division of Geriatrics at UCSF. “The accuracy of prognostic indices is often tested under ideal and controlled conditions,” he said. “When you see a research report of a prognostic index, you see how well it did in a group of patients specified by the researchers. But how accurate will the index be in your patient? […] Your patients are never quite the same as the patients in the research study.”
As a prognostic aid, programs like ePrognosis may turn out to be quite valuable, “if used to supplement clinical judgment,” said Dr. Covinsky. “Clinicians (and patients too) now have easy access to these prognostic indices. […] But perhaps the danger of ePrognosis is that it is too easy. In a matter of minutes, you can input a few elements of patient data and the calculator will spit out a probability of survival,” he added.
Some critics have pointed out that the very idea of basing decisions in medical care on calculations such as these may be a slippery slope. They say that assessing a patient’s life expectancy should never be the starting point of any form of treatment. Dr. Lee freely admitted there are potential problems. Because it is not clear whether calculating prognostic indices will ultimately improve patient care in clinical settings, he said, the researchers stopped short of urging widespread use at this time, according to the Times.
Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”, which is available on her blog, “Food and Health with Timi Gustafson R.D.” (http://www.timigustafson.com), and at amazon.com. You can follow Timi on Twitter (http://twitter.com/TimiGustafsonRD) and on Facebook.
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