Doctor, How Long Do I Have?

A new tool to help doctors and patients discuss life expectancy. 

From my posts, I hope my bias for my home institution is not too burdensome.  Unfortunately, I cannot help it if the Geriatrics faculty at the University of California at San Francisco churn out an innovation a week.   This week?  A major advance in how we can prognosticate for our patients.

Prognosis is an inherently difficult process for doctors.  How do we, as a medical community, really know how long a patient has to live?  What should we tell her about what we do know?  It is often difficult to determine a person’s prognosis if she does not have one specific disease that can guide us.  It would be helpful to always be able to say something specific; for example, “We know that women with your stage of lung disease generally live another 6 to 8 months with the treatments we can offer you.”

The difficult place for doctors to prognosticate accurately is when a patient has many diseases, none so severe that one overshadows the others.  And sadly, many doctors do not, as a result, discuss life expectancy with their older patients who often have multiple diseases. Despite this, we increasingly have evidence that patients and their families want to know what the future holds so they can plan and make medical decisions accordingly. And that doctors should start these conversations.  Drs. Alex Smith, Brie Williams and Bernard Lo made this case quite convincingly in a recent New England Journal of Medicine article.

Now we have a tool to help us and patients discuss prognosis and overall life expectancy.  And it’s publically available!

Uniting different research done on larger populations and tools developed from this research, eProgosis.org, is a platform for using 16 different estimators of life expectancy for older adults in different settings—nursing homes, hospital, the community—and it leads you through each calculator.  In the end, you get an estimated life expectancy.  And anyone can use it.

The media buzz around this tool  (see articles listed below) has emphasized what should be understood well by anyone using it—this is not a crystal ball.  These are tools based on studies of groups of people, and therefore cannot be exact with an individual.  Also, because certain populations are used in the studies to derive the tools, it may not apply to everyone who plugs in his or her information.  It is unclear, for example, how this extends to international populations, which were not studied.  Therefore, the results should always be discussed with a doctor.

Regardless, ePrognosis is a remarkable leap forward.  It is an accessible and useable tool that uses the best information on how to predict life expectancy in complicated older adults.  It creates a way for patients and doctors to begin these critical conversations with real information.  Explore it, and see what you think!

ePrognosis website: http://www.eprognosis.org/

Blogs and articles mentioning ePrognosis:

1) The Daily Beast Newspaper: http://www.thedailybeast.com/articles/2012/01/14/online-mortality-calculator-could-change-health-care-and-our-views-on-death.html

2) GeriPal Blog: http://www.geripal.org/2012/01/prognostic-indices-in-patient-care.html

3) NY Times, New Old Age Blog: http://newoldage.blogs.nytimes.com/2012/01/10/how-long-until-the-end/?scp=2&sq=eprognosis&st=cse

4) NY Times article on JAMA paper: http://www.nytimes.com/2012/01/11/health/using-interactive-tools-to-assess-the-likelihood-of-death.html?scp=1&sq=eprognosis&st=cse

Recent academic articles on prognostic indices:

1)   Yourman LC, Prognostic Indices for Older Adults. Journal of the American Medical Association (JAMA), 2012;307(2):182-192, http://jama.ama-assn.org/content/307/2/182.short

2)   Smith AK, Williams BA, Lo B.  Discussing Overall Prognosis with the Very Elderly.  New England Journal of Medicine (N Engl J Med), 2011; 365: 2149-2151. http://www.nejm.org/doi/full/10.1056/NEJMp1109990

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About agannac

Agannac is an internal medicine trained physician, currently doing further training in geriatric medicine. She enjoys working with vulnerable elderly in the health care setting and thinking about ways to improve health care for the most socially and medically complex. She hopes to make innovations from around the world relevant in the US.

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