The Central Role of Prognosis in Clinical Decision Making

JAMA Network | JAMA: The Journal of the American Medical Association | The Central Role of Prognosis in Clinical Decision Making

Physicians should be trained to consider prognosis in their clinical decision making. As a starting point, age-, sex-, and race-specific life expectancies (median and interquartile range) can be calculated using data from standard life tables.
Physicians could then make qualitative judgments, based on information from the medical record or clinical assessment, about whether a patient is likely to live substantially longer or shorter than an average person in his or her age and race cohort. The strongest and most consistent predictors of mortality in older persons include comorbidity and functional status. Lung disease requiring regular use of corticosteroids or supplemental oxygen, New York Heart Association class III or IV congestive heart failure, renal disease requiring dialysis, advanced dementia, inability to walk more than a block, and need for personal assistance with bathing are examples of factors that would reduce life expectancy substantially below the average.
The absence of significant comorbid conditions or functional limitations would identify older persons who are likely to live longer than average.