The Central Role of Prognosis in Clinical Decision Making

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 expectency, 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 colleagues evaluate 16 validated, non-disease specific indices that predict mortality for older persons (1).The authors rigorously assess each index for generalizability, accuracy and potential bias.They conclude that none of the indices is ready for widespread use in clinical practice.Even if one or more of these prognostic indices had passed or exceeded the specified quality benchmarks (2-4), their clinical utility would be uncertain.