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January 11, 2012

The Central Role of Prognosis in Clinical Decision Making

Author Affiliations

Author Affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.

JAMA. 2012;307(2):199-200. doi:10.1001/jama.2011.1992

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,2-4 their clinical utility would be uncertain.