ePrognosis.org is a free online tool designed to help healthcare professionals determine their elderly patients’ risk of mortality, based on the results of a systematic review in JAMA. This is useful information for clinicians in discussing treatment and preventive care options with their patients. For example, a patient who is unlikely to live more than a year longer may not wish to undergo painful medical treatments that won’t have any benefit to them during that year. Risk of mortality is also used to decide whether a patient is eligible for hospice. For examples of situations in which these indices would be useful, check the website’s How to Use page.
The site provides several different indices for prognosis. How appropriate each one is for a given patient depends on the patient’s situation, such as whether they are living in the community, in a hospital, or in a nursing home. The front page with the bubbles also arranges the indices according to accuracy, usability, and a few other factors; the ones on top are the best, the ones on the bottom are the least accurate. The size of a bubble indicates its popularity among users of the site. If you don’t like the bubble format, click “Calculators” at the top to get to a more basic list. Note that the list on the Calculators page doesn’t sort by accuracy.
The issue of accuracy causes concern in some people; these indices do not take into account many factors of an individual patient’s health that may affect their life expectancy. As you can guess from the arrangement by accuracy, there is no guarantee that they will be correct. The creators urge users of the indices not to use them as the sole source of information for making decisions, and to consider any factors in a patient’s life that could affect their life expectancy that are not considered in an index.
Other concerns arise from the site being open to the public, generally that people will be unable to understand the indices and their results. For example, the results don’t tell you how long a patient will live, they say how many people in a condition similar to the patient’s would die within the time period given by the index. Many also require rating the patient on various scales used in health care that aren’t known to the general public, making them rather hard to use. The creators caution anyone who is not a health care professional who uses the site to talk with their doctor.
Here are a few blog posts explaining some of the issues in more detail:
- Prognostic Indices In Patient Care: Useful or Waste of Time? discusses the accuracy of prognostic indices.
- A New Tool for Estimating Prognosis in the Elderly and Eprognosis gets Half a Million Hits in the First Week mention the reasoning behind making ePrognosis open to the general public.
<submitted by Vicki Burchfield>
