My day in clinic always starts with a huddle. As part of our Patient Centered Medical Home (PCMH) care model, every provider huddles with their assigned nurse/team. During huddle, we are presented the current clinic “hit list” of which patients are overdue on their hemoglobin A1c, immunizations, mammograms, colonoscopies, etc. These HEDIS measures are tracked by the hospital and are tied to our provider report cards.
As you may imagine, many providers strive for “straight A’s”. But are we doing more harm than good when it comes to cancer screening for patients with a poor prognosis? How do we even know what a patient’s 5 or 10 year prognosis actually is? How do we reconcile recommendations from the United States Preventive Services Task Force (USPSTF) and/or the American Cancer Society (ACS) with the patient and or their family member’s desires for screening? How do we break down seemingly complex evidence based practice concepts such as numbers needed to screen/harm to our patients? Is it ethical to withhold screening or even have the conversation? Or is it more unethical to screen patients with dementia, advanced cancer, COPD, CHF?
The answers to the above questions are between providers and their patients, but having information to jumpstart an intelligent conversation is critical. The authors of the popular blog, GeriPal, have created a medical app to help with these difficult conversations. The ePrognosis Cancer Screening app was developed by providers at the University of California, San Francisco, Harvard and Bandwdth Publishing. The medical app walks providers through a series of 15 questions about a patient’s health in order to calculate their life expectancy/prognosis as it relates to either breast or colon cancer or both. The medical app then displays a “speedometer” of sorts showing a needle between harms and benefits. The medical app also displays evidence-based pictographs showing the number need to screen/number needed to harm by performing these screening tests. The authors have an excellent explanation of how best to use the app on their blog.
Evidence based medicine
The ePrognosis Cancer Screening app calculates a patient’s prognosis based on validated questions for breast/colon cancer screening and presents the results in highly useful pictographs that permit explanation of numbers needed to screen and harm in terms that are easily understandable to providers, patients and their families.
Who would benefit from this App?
Any healthcare provider who cares for geriatric patients including students, NP’s, PA’s, geriatricians and other primary care providers who order screening tests.
Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.
- Fabulous user interface with highly useful pictographs for use at the POC with patients/families.
- Extensively referenced with useful links.
- Detailed instructions on proper use of the app and interpretation of the results.
- Fills a void in screening recommendations that mention prognosis but fail to provide a useful mechanism to calculate prognosis.
- Limited to only breast and colon cancer screening.
- No Android version.
A real find for all of us in primary care who are seemingly stuck between “doing what is right” for our patients and meeting HEDIS measures, and pressures from patients and families. The ePrognosis cancer screening medical app doesn’t “preach” what to do, but merely gives evidence based data to have an intelligent conversation on a patient’s prognosis and the risks/benefits of colon/breast cancer screening. We ideally need tools like this for MANY of the tests we may be ordering unnecessarily.
- Overall Score
- User Interface
An outstanding interface that blends simplicity with detailed explanations of how to use and interpret the medical app’s results. Fantastic pictographs to use with patients at the POC.
- Multimedia Usage
Outstanding use of a simple 15 question score with detailed pictographs demonstrating patient prognosis, benefits and harms in easy to understand terms. App includes detailed references and links.
App is free.
- Real World Applicability
A necessity for any provider who cares for older patients and orders cancer screening tests. This medical app is educational for both provider and patient and will help many of us in primary care have an intelligent conversation with our patients regarding the potential benefits and harms of cancer screening.
- Device Used For Review
iPhone 6S running iOS 9.2
- Available for DownloadiPhoneiPad