The science of clinical practice: disease diagnosis or patient prognosis? Evidence about “what is likely to happen” should shape clinical practice

BMC Medicine

Adam Timmis⁶  Michael Von Korff^1,11  Danielle A Van Der Windt^1,13  Richard J Stevens^1,12  Michael Sharpe⁹  Ian Roberts¹  Richard D Riley³  Steffen E Petersen⁸  Pablo Perel¹  George Peat^1,13  Linda LeResche⁴  Harry Hemingway²  Alastair D Hay⁵  Kate M Dunn^1,13  Jonathan J Deeks⁷  Douglas G Altman^1,10  Peter Croft^1,13 

[1] Epidemiology & Population Health Faculty, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;Farr Institute of Health Informatics Research, London, and UCL Institute of Health Informatics, London NW1 2DA, UK;Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham B15 2TT, UK;School of Dentistry Office of Research, Box 357480, University of Washington, Seattle 98195, WA, USA;Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK;NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London EC1M 6BQ, UK;School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK;William Harvey Research Institute and NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London EC1M 6BQ, UK;Oxford Psychological Medicine Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK;Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK;Group Health Research Institute, Group Health Cooperative, Seattle 98101, WA, USA;Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK;Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele ST5 5BG, Staffordshire, UK

关键词: Stratified medicine;    Prognosis;    Overdiagnosis;    Outcomes of care;    Information;    Evidence-based medicine;    Diagnosis;    Contested diagnoses;    Clinical decision-making;   

Others  :  1109694
DOI  :  10.1186/s12916-014-0265-4

 received in 2014-09-19, accepted in 2014-12-24,  发布年份 2015

【 摘 要 】

Background

Diagnosis is the traditional basis for decision-making in clinical practice. Evidence is often lacking about future benefits and harms of these decisions for patients diagnosed with and without disease. We propose that a model of clinical practice focused on patient prognosis and predicting the likelihood of future outcomes may be more useful.

Discussion

Disease diagnosis can provide crucial information for clinical decisions that influence outcome in serious acute illness. However, the central role of diagnosis in clinical practice is challenged by evidence that it does not always benefit patients and that factors other than disease are important in determining patient outcome. The concept of disease as a dichotomous ‘yes’ or ‘no’ is challenged by the frequent use of diagnostic indicators with continuous distributions, such as blood sugar, which are better understood as contributing information about the probability of a patient’s future outcome. Moreover, many illnesses, such as chronic fatigue, cannot usefully be labelled from a disease-diagnosis perspective. In such cases, a prognostic model provides an alternative framework for clinical practice that extends beyond disease and diagnosis and incorporates a wide range of information to predict future patient outcomes and to guide decisions to improve them. Such information embraces non-disease factors and genetic and other biomarkers which influence outcome.

Summary

Patient prognosis can provide the framework for modern clinical practice to integrate information from the expanding biological, social, and clinical database for more effective and efficient care.

【 授权许可】

   
2015 Croft et al.; licensee BioMed Central.

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