A team led by researchers from the San Francisco VA Medical Center and the University of California, San Francisco has completed the first systematic review of prognostic indices used to calculate a patient’s life expectancy, and created a website that puts these indices in one central location.

The review concludes that the most accurate and usable indices might have value when used in conjunction with other clinical information.

Alexander K. Smith, MD, MPH

The review appears in the January 11 issue of the Journal of the American Medical Association. The prognostic indices are collected at www.eprognosis.org.

Many medical interventions have guidelines recommending that doctors take a patient’s life expectancy into account, said senior investigator Alexander K. Smith, MD, MPH, a palliative medicine doctor at the UCSF-affiliated SFVAMC.

Given this goal, he said, “It would be ideal if there were one index that would allow you to plug in your patient’s information — age, diseases, functional impairments — and get an accurate long-term prognosis,” Smith said. “Unfortunately, there is not. In the absence of that, we have this systematic review and corresponding online compendium, which we hope physicians will find a useful adjunct, along with patient preferences and their own professional judgments, in making clinical decisions that involve life expectancy.”

The authors note that the 16 indices need further independent testing for accuracy in different settings, and that further studies are needed to show whether use of the indices improves clinical outcomes. In the meantime, they have made the indices more accessible to clinicians and patients who are interested in the information they provide.

“We often don’t talk about prognosis with our patients, and, as clinicians, we are, frankly, not trained to think about it,” said lead author Lindsey Yourman, MD, a medical student at UCSF at the time of the study. “This can lead to unnecessary suffering when we order invasive interventions for patients who may not live long enough to benefit from them.”

At the same time, she noted, prognostic indexes are not intended to limit care for elders. “In some instances,” she said, “they may lead to more interventions. For example, some older patients may not be offered cancer screening due to their age, but a prognostic index may suggest they are healthy and likely to benefit from cancer screening because of long life expectancy.”

Website Prognosticates for Typical Geriatric Patients

There are already websites with prognostic calculators, said Smith, but they exist for patients with specific diseases. “This is the only site we know of that helps physicians prognosticate for older adults with multiple conditions,” he said. “So it’s applicable to the typical geriatric patient.”

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