Medline ® Abstracts for References 3,4
of 'Communication of prognosis in palliative care'
Complexities in prognostication in advanced cancer: "to help them live their lives the way they want to".
Lamont EB, Christakis NA
Predicting survival and disclosing the prediction to patients with advanced disease, particularly cancer, is among the most difficult tasks that physicians face. With the de-emphasis of prognosis in favor of diagnosis and therapeutics in the medical literature, physicians may have difficulty finding the survival information they need to make appropriate estimates of survival for patients who develop cancer. Quite separate from the challenge of estimating survival accurately, physicians may also find the process of disclosing the prognosis to their patients difficult. Using the vignette of a real patient with advanced cancer who far outlived her physician's prognostic estimate, we discuss clinical issues related to the science of prognosis in advanced cancer and the art of its disclosure.
Section of General Internal Medicine, Department of Medicine, and the Cancer Research Center, University of Chicago, Chicago, IL, USA. firstname.lastname@example.org
Prognostic indices for older adults: a systematic review.
Yourman LC, Lee SJ, Schonberg MA, Widera EW, Smith AK
JAMA. 2012 Jan;307(2):182-92.
CONTEXT: To better target services to those who may benefit, many guidelines recommend incorporating life expectancy into clinical decisions.
OBJECTIVE: To assess the quality and limitations of prognostic indices for mortality in older adults through systematic review.
DATA SOURCES: We searched MEDLINE, EMBASE, Cochrane, and Google Scholar from their inception through November 2011.
STUDY SELECTION: We included indices if they were validated and predicted absolute risk of mortality in patients whose average age was 60 years or older. We excluded indices that estimated intensive care unit, disease-specific, or in-hospital mortality.
DATA EXTRACTION: For each prognostic index, we extracted data on clinical setting, potential for bias, generalizability, and accuracy.
RESULTS: We reviewed 21,593 titles to identify 16 indices that predict risk of mortality from 6 months to 5 years for older adults in a variety of clinical settings: the community (6 indices), nursing home (2 indices), and hospital (8 indices). At least 1 measure of transportability (the index is accurate in more than 1 population) was tested for all but 3 indices. By our measures, no study was free from potential bias. Although 13 indices had C statistics of 0.70 or greater, none of the indices had C statistics of 0.90 or greater. Only 2 indices were independently validated by investigators who were not involved in the index's development.
CONCLUSION: We identified several indices for predicting overall mortality in different patient groups; future studies need to independently test their accuracy in heterogeneous populations and their ability to improve clinical outcomes before their widespread use can be recommended.
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA 94121, USA.