Wednesday, March 29, 2006

Art Buchwald; academic prognosis

More digest entries...

As some of you may know the columnist Art Buchwald has been in a hospice for over a month now as he has decided to forego dialysis.  He has still been writing columns from the hospice (this is a link to all his columns at the Washington Post--you may have to do a free sign-in if you want to read several columns).  Several have been about hospice, death & dying, and even surrogate decision making (he's also recently written about sperm donation, and taken a moment to roast President Bush).  These are non-medical, first-person accounts of dying, decision-making, and hospice which are very rare in the U.S.--especially for such a public figure--and quite interesting to read.  One sort of hopes he lives a long time and keeps on writing, and that others follow.  Thanks to Laurie Lyckholm MD (at VCU) for letting me know about these.

There seems to be a flurry of prognosis type articles in the last few weeks, and here are two more (although these are interesting only from an academic [non-clinical] perspective).

The Journal of General Internal Medicine has an article on mortality risk based on a single disclosure of health status.  It is actually a meta-analysis of studies looking at patient's self-reported global health status, i.e. asking "In general, how would you rate your health?"   They analyzed the results of 22 studies and found that those who stated they had poor health had about a two-fold increased relative risk of death than those who had excellent health.  The studies followed people from ~4 to over 25 years.  

The Journal of the American Geriatrics Society has a piece about the prognostic value of the Vulnerable Elders Survey-13, which is a 13 item tool in which elderly patients answer simple questions about functional status, age, and global health status (aha!).  This was a validation study using a cohort of community dwelling older adults who were screened with the VES-13 upon entry into the study--they were followed for up to 14 months.  Mortality increased with vulnerability score, with the highest group having a ~30% mortality during follow-up.  Again, the clinical utility of this is unclear, and would seem to be best in screening people at highest risk of death or decline (and thus in need of more or different health care services), much like the BMT index, but how much any of this adds to usual clinical care. 

3) JAGS also has an interesting looking article by D Casarett about patients' preferences for life-sustaining care as a barrier to hospice enrollment.  I haven't read it yet but it looks good.

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