Thursday, January 8, 2015

Let's Talk About Prognosis

GeriPal's very own Alex Smith recently gave an absolutely fabulous "Ted-like" talk in which he made the statement that "prognosis needs to be a part of everyday medical care."  Unfortunately, as he so eloquently states in the video (which can be watched here), it isn't always taken into account.

To dive a little deeper into the lack of prognosis in health care decision making, lets just take a look at cancer screening.   Individuals with a limited life expectancy are exposed to all the immediate harms from a screening test, yet may not live long enough to see any of the benefit (the concept of lag-time-to-benefit).   Yet, people with limited life expectancy still get these screening tests as evident by the following studies:
This is part of the reason that we created the ePrognosis: Cancer Screening decision support app to help guide conversations with elderly patients of whether to start, stop, or continue breast cancer and/or colorectal cancer screening. We recently updated it to give it a new look and feel, and for all you non-iPhone users, we are close to releasing a version that can be used on any mobile device (and yes, it will remain free of charge).

In Alex's video, he leave the audience with a challenge, one that I'll give to the GeriPal viewers as well.  Alex asks the audience to use "ePrognosis once a week for the next month.   See how it changes your perspective.   See how it changes the conversations you have with your patients."

by: Eric Widera (@ewidera)

The ePrognosis Cancer Screening app


Yvonne Fried, MD said...

Thank you very much for posting this talk. It speaks to the heart of what I need to do in my medical practice as a gynecologist with an aging patient population. It's always easier to stay in the rut of one's practice behaviors than it is to change. I look forward to working with ePrognosis on my iPhone. Thank you Eric Widera and Steve Jobs.

Laura Newman said...

This is important work, but there remains an immense gap in discussion of palliative care in individuals without cancer diagnoses...perhaps in no small part because their prognostic trajectory is less clear.