How much longer can I expect to live? Can a physician truly answer this question? Prognosticating is one of the most challenging tasks clinicians face. It is often difficult to gauge a patient’s life expectancy, especially for patients without adominant terminal illness like advanced dementia, cancer or congestive heart failure. In fact, clinicians typically make overly optimistic estimates of patient survival. Nowadays, clinicians are much less versed in discussing prognosis than treatment options. A 1998 national survey of 697 physicians showed that 57% felt inadequately trained in prognostication. (Christakis and Iwashyna, Arch Intern Med, 1998)
ePrognosis - Estimating Prognosis for Elders, this month’s POGOe Editor’s Choice, is an interactive repository of 16 published geriatric prognostic indices where clinicians can enter individual patients’ information and have prognostic information calculated for them. The site’s algorithm is based on the developers’ systematic review of validated geriatric prognostic indices (JAMA, 2011) that can assist clinicians in discussions with patients.
The home page of the site brings you to a sorting algorithm that utilizes an interactive visual chart with the 16 indices, represented as balloons. The balloons are sorted based on the quality of the prognostic indices and their predictive time-frame measured in years. The balloon’s size correlates to its usefulness or clinical efficacy. Hovering over a balloon provides a brief description of the index and most importantly, the geriatric population for which it is most valid. Double clicking will link to the actual calculator for the risk model and provide the predicted outcome, its discriminatory characteristics as well as its calibration. The calculators are easy to complete, with drop-down menus for each patient variable. The site also asks the user to provide their best guess for the outcome risk. The user gets a calculated percentage likelihood of death within a particular time frame as determined by the index used.
The tabs on the top of the home page allow users to navigate through the list of indices, the rationale for each tool, and directions on using the site. External links to geriatric assessment tools, references and other website sources are available throughout the site. ePrognosis’s sister site, GeriPal, the Geriatrics and Palliative Care blog site, is featured prominently. An interesting area on the site is the feedback page where site users can leave non-moderated comments. This is not for the faint of heart, since the comments range from the insightful to just plain inane. This wide range of comments is not surprising for a site which in its first five weeks, according to the AARP, attracted more than half a million visits from clinicians and the general public alike.
The site developers offer a caveat to their tool: Clinicians should keep in mind that every patient is an individual, and that many factors beyond those used in the indices may influence a patient’s prognosis. It should not replace the patient-provider relationship. So try it out here in POGOe.