Editorial |

The Central Role of Prognosis in Clinical Decision Making

Thomas M. Gill, MD
JAMA. 2012;307(2):199-200. doi:10.1001/jama.2011.1992.
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In clinical practice and training, estimating prognosis—the probability of an individual developing a particular outcome over a specific period of time—typically receives less attention than diagnosing and treating disease. Yet many clinical decisions are not fully informed unless the patient's prognosis is considered. Because of competing chronic conditions and diminished life expectancy, careful consideration of prognosis is particularly important for clinical decision making in older patients. In a systematic review in this issue of JAMA, Yourman and colleagues1 evaluated 16 validated, non–disease-specific indices that predict mortality for older persons. The authors rigorously assessed each index for generalizability, accuracy, and potential bias. They concluded that none of the indices is ready for widespread use in clinical practice. Even if 1 or more of these prognostic indices had passed or exceeded the specified quality benchmarks,24 their clinical utility would be uncertain.

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May 9, 2012
Ralph Stern, PhD, MD
JAMA. 2012;307(18):1911. doi:10.1001/jama.2012.3538.
May 9, 2012
Alexander K. Smith, MD, MS, MPH; Lindsey C. Yourman, MD; Sei J. Lee, MD
JAMA. 2012;307(18):1911-1912. doi:10.1001/jama.2012.3615.
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Users' Guides to the Medical Literature
Chapter 11.1. Applying Results to Individual Patients

Users' Guides to the Medical Literature
Chapter 22.2. Decision Making and the Patient