How many years do you have left?

I just finished submitting a manuscript that looked at the differences in laboratory testing expenditures over time (a pretty staggering increase over a ten-year period in case anyone was wondering) and tried to understand what explains these increases.  It seems pretty innocuous, a blood test here, a bacterial smear there.  But its adding up fast.  Is it that we're sicker than we used to be, is the Canadian population getting older, does new technology cost that much more or is it just plain ol' over-testing?



You're going to have to wait for my paper to be published to find out...but the media tends to pin the tail on the older population.  It got me thinking about testing and treating older patients.  Far too often, clinicians have a difficult decision to make.  They've got to weight remaining life expectancy in their decision about the treatment protocol they are going to follow with their elderly patients.  Some patients are far too frail to handle the treatment regiment and sometimes, elderly patients just don't respond the same way as younger patients do to drugs and operations.  In which case, instead of poking, prodding and subjugating them to treatments which their bodies cannot handle, ensuring they have a good quality of life for the years they have remaining becomes a priority.  Other patients are pretty robust even at an advanced age and may be able to handle the testing and treatment with more immediate benefits.  Its a hard decision (and conversation) to have and research has shown that clinicians aren't very good at assessing how many years their patient has left.

However, recently, researchers from the University of California, San Francisco, have developed interactive online tools to help clinicians make this decision, available at www.eprognosis.com.  Made up of 16 assessment scales, the tools allow clinicians to input pertinent information regarding their patients to determine the likelihood of death.  The tools are reasonably accurate, but they are also particularly useful in encouraging clinicians to have a much needed honest dialogue about prognosis in this fast growing population.

What's equally interesting is that they have opened the website for public use.  There was much debate about this decision, but I agree with the researchers that patients should be allowed to access this information if they want to participate in their health care decisions and at the very least it will allow them to have a open conversation with their physician.  Having been to the website, you need to have specific health care information such as functional ability and cognitive status to use the tools and they are clearly marked as being 'moderate' to 'very good' in their accuracy.  The caution is that these are only tools and that the information they provide needs to be considered in the larger context of other information that only a health care professional will have the expertise to weigh.  Still, as one of the researchers put it, "its a philosophical question" and in this case, a more informed patient is probably one who will want to have that conversation.