ePrognosis App- A guide about the Screening Of Cancer. It’s designed to aid in one of the most important issues in primary care cancer screening for older adults.
Have you ever wondered while considering the possibility of a cancer screening test for an older person what the potential harms outweigh the potential advantages?
Perhaps you’ve done it, but maybe you didn’t. The following sentence is in reality an odd formula for the following questions:
- How many years is this person most likely to live, based on the health and age of the person?
- With this patient’s outlook is cancer screening a good idea? sense?
The first question is one that is likely to occur to anyone whether someone who is a patient, family member, or even a medical professional – but I’m guessing that it isn’t thought of at the rate it ought to.
For the second one I’m not certain what frequency it is that it will pop into the minds of people however it’s definitely important to think about, considering the information we have about the numerous risks of cancer screening for the elderly and, in general, not as often positive effects.
Additionally, there’s plenty of evidence to suggest that “inappropriate” cancer screening remains prevalent. “Inappropriate” meaning the screening of patients who are sick or old that they aren’t likely to be able to live long enough to benefit from screening.
One shocking study revealed it was 25percent of doctors indicated that they’d recommend colon cancer screenings for an elderly patient who has non-operable lung cancer. Therefore, it’s evident that improving decision-making about cancer screening could increase the quality of health, safety and worth.
Explore the ePrognosis cancer screening app it’s the first application developed in UCSF’s the ePrognosis team. It’s free to download from the iTunes store and, it was co-created by Eric Widera, who is a geriatrician as well as a friend of mine, it was developed to be utilized by the general public as in the hands of clinicians.
The app is basically designed to work in this way:
- Tell it if you’re looking to test for colon cancer or both.
- The app asks you fifteen questions about your health and whether certain activities are challenging for you. (The tests are a mix from those from the Lee as well as the Schonberg mortality indices; click the link below on the question as well as pertinent scientific sources.)
- Then, you are given a decision on whether screening for cancer is recommended as well as a clever speedometer graph that shows the harms vs. advantages.
- When the user clicks “Learn more” you are shown a variety of images showing information about the expected risks and benefits of screening. You also get details on the percentage of the population will die in this period of time, regardless of whether or not they’re checked for cancer.
- You can also share and then reportedly share the report with someone else. (Note that I was unable to make this be effective with me.)
For more details about the app, including great screenshots, go through the GeriPal blog post that introduces the application.
Utilizing prognosis From the research phase to an ePrognosis to…app?
Will the app function according to the hopes of its creators? That is, will it aid both clinicians and patients make better choices about cancer screening in older people? Also, will it help reduce inappropriate cancer screening among older adults?
Prognosis is after all an extremely difficult subject. Although you may be able to get accurate prognostic data when you require it, navigating discussions and making decisions based on the information you have isn’t easy. For example this survey of qualitative data on seniors discovered that while the majority of participants were willing to discuss the life expectancy of their loved ones, about three-quarters of them viewed the discussions as useless or even detrimental. (Interestingly 64% of respondents believed that their doctors could not accurately determine their life expectancy.)
The project called ePrognosis is designed to address the initial part of the problem in that the practical prognostic information is difficult for clinicians in the front line – and everyday people to locate. For instance, even the present, UpToDate has no information on how to calculate life expectancy for older adults, despite numerous guidelines urging doctors to incorporate prognosis into their medical decisions. (For an excellent slideshow of the reasons we should consider using prognosis, go this.)
In contrast, UpToDate has a page with the title ” Communication of Prognosis in Palliative Care” written by the UCSF’s Alex Smith, co-creator of the ePrognosis. The website has a wealth of information regarding how clinicians can communicate prognosis. However, because of the title, it may not be easily recognized by doctors looking for a simple method to determine the life expectations. (“How to inform patients about the length of time their lives are likely” may be more popular from generalists.)
I too enjoy the site ePrognosis in its concept. However, I’ve recently was able to admit my friend Alex that I’ve barely used it. Whyis that? Most likely because my clients tend to be rather frail and old and I’m feeling that I’m already infusing the notion of their short lifespan into my advice and discussions with them.
Here’s the problem The clinicians who are thinking about using ePrognosis, or of using life expectancy in their decision-making process, are likely not the ones who must use something similar to ePrognosis. (Not that we’re flawless – I’m sure having more decision support could help me, but we’re not the ones who would order cancer screening for an 80-year old suffering from lung cancer that is not operable.)
The ePrognosis case illustrates a widespread problem in improving the quality of healthcare as the issues that experts observe at the level of the population (excess cancer screening among elderly people) are seen in different ways by patients and clinicians in the field (clinicians and patients have traditionally been able to demonstrate an enthusiasm to undergo the screening).
But altering the behavior of people – the only way to fix the quality of your life – is difficult, especially when individuals remain within their normal environment. While expert advice and guidelines are important to play, they’re not enough to change the attitudes and habits of those who are who are in the trenches.
However in the pursuit of improving the health of older adults developing tools to measure and share the life expectancy of an individual is a good beginning. Once a tool is created it is feasible to determine the way people react to it, then refine it, enhance it and think of ways to make it more accessible to those who need it at the most appropriate moment. One can even envision specific tools being integrated into the clinical processes to nudge both patients and doctors toward (or towards) certain behaviors.
Now, where do consider we should take us to go from this point, in case you are looking to utilize prognosis in order to improve health care, and value for healthcare, for people who are older? The authors of ePrognosis would like comments and suggestions for the next steps. Visit the website of ePrognosis and try the application and leave your ideas by leaving a comment.
I’ve just put information about an elderly patient in the ePrognosis Gagne index and it predicted an average of 30% likelihood of dying in the coming year. Hm… Perhaps I’ll revisit the UpToDate webpage regarding discussing prognosis because the patient is scheduled to have an advanced care plan discussion. The page outlines five steps for discussing prognosis.
Do you think it should be part of an app?
Leslie Kernisan, MD MPH is a practicing physician, careful techno-optimist, and enthusiastic caregiver educator. She would like to one day be surrounded by amazing technology and breakthroughs that ensure that great geriatric care is accessible to everyone, particularly primary caregivers and family members. She is a frequent THCB contributor and writes on Geritech.org as well as at drkernisan.net.