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Patient perception, prognostic calculators should be used together in survival estimation

An analysis of objective, subjective and observed survival demonstrated significant differences between subjective and objective survival estimates, according to research published in JAMA Internal Medicine.

Rafael D. Romo, PhD, RN, division of geriatrics, University of California, San Francisco, and colleagues reported that use of prognostic tools can aid in lessening the difference.

"Patients' perceptions of prognosis are important," Romo and colleagues wrote. "Clinicians who follow recommended guidelines may urge patients to change health routines to which they have become accustomed. Patients who underestimate their survival may choose to forego interventions that are likely to help them, while those who overestimate may choose to undergo interventions that are more likely to cause harm."

Rafael D. Romo

The researchers selected a sample of participants from the Health and Retirement Study, a longitudinal, prospective cohort study of a nationally representative population of adults in the United States. The final sample included 1,722 participants who were divided into groups by age: 64 years (n = 544), 69 years (n = 447), 74 years (n = 322), 79 years (n = 265) and 84 or 89 years (n = 144).

Participants were asked to estimate their survival by reporting the percent chance they believed they would live to the following ages: 75, 80, 85, 90, 95 or 100 years. Romo and colleagues compared their estimations with an objective estimate using the Lee life expectancy calculator and observed survival using mortality through 2010, which was confirmed via the National Death Index.

Results showed that 54.7% of participants provided an estimation that was similar to the objective calculation. Additionally, 32.7% of participants underestimated and 11.5% overestimated. Romo and colleagues noted that, underestimation was similar between age groups; overestimation increased as age increased (P < .001).

The researchers recommended the use of prognostic calculators, which have shown greater accuracy than participants' subjective estimates and clinician estimates.

"Clinicians should solicit patients' individual perception of prognosis and use this information as a starting point for further discussion, particularly among older patients who may be more prone to errors," Romo and colleagues wrote. "Then, in conjunction with prognostic tools, they can begin to bridge the gap between subjective and objective estimates of survival." – by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.