Sei Lee: Having an accurate determination of life expectancy, we can make sure that we are recommending the care that is most likely to help. I think as a clinician the thing that I find most valuable about ePrognosis is it allows me to broach a sensitive topic with patients in a non-threatening way. It's a starting point for discussion.
Alex Smith: A lot of times when doctors are making decisions about what sort of tests or treatments to recommend for patients, they consider the benefits, but don't have a great sense of the burdens. So what we know from colon cancer screening is it takes 5 to 10 years to benefit from the screening tests. So if a patient has a life expectancy of less than 5 to 10 years and then has a cancer screening test, then they experience all the potential harms like false positives, risk of colonic perforation during colonoscopy, without the potential to live long enough to experience the benefit.
In the indices that we include on ePrognosis they converted those risks into a point score. We searched the literature, reviewed thousands of titles and then found 16 generalized validated prognostic indices for older adults.
Sei Lee: A recent patient that I saw in the hospital expressed his desire to not come to the hospital as much. So, I was able to have him talk to me in front of the computer, use the website and really talk very explicitly about what his prognosis was. We were able to design a system of care that allowed him to stay at home with additional support.
Alex Smith: Our sense from patients was that they're willing to talk about these issues. They prefer their physicians bring it up. Our intention is to the help clinicians, patients, caregivers to make informed decisions so that they on balance are receiving tests and treatments to experience the benefits more than harm them.