What are the tips for prognosis (prediction of disease outcome)?

From the Guidelines

The prognosis for patients with advanced cancer should be discussed in a clear and compassionate manner, taking into account the patient's needs, goals, and priorities, as recommended by the American Society of Clinical Oncology consensus guideline 1. When discussing prognosis, clinicians should provide diagnostic and prognostic information that is tailored to the patient’s needs and that provides hope and reassurance without misleading the patient.

• Clinicians should reassess a patient’s goals, priorities, and desire for information whenever a significant change in the patient’s care is being considered.
• Clinicians should provide information in simple and direct terms.
• When providing bad news, clinicians should take additional steps to address the needs and responses of patients. The patient's prognosis can be influenced by various factors, including the type and stage of cancer, overall health, and treatment options.
• Accurate prediction of survival is still necessary for clinical, organizational, and ethical reasons, especially in helping to avoid harm, discomfort, and inappropriate therapies in vulnerable patients and, conversely, in planning specific care strategies 1.
• Establishing an accurate prognosis is part of the therapeutic alliance, and patients have a right to be informed of their prognosis or, if they prefer, not to be informed 1. Clinicians should provide information about prognosis in a variety of formats, such as median, best/worst case, and milestones, and cultivate prognostic awareness over time, as recommended by the Journal of Clinical Oncology 1.

From the FDA Drug Label

In two placebo controlled, 12-week clinical studies compared the addition of lisinopril up to 20 mg daily to digitalis and diuretics alone. The combination of lisinopril, digitalis and diuretics reduced the following signs and symptoms of heart failure: edema, rales, paroxysmal nocturnal dyspnea and jugular venous distention A large (over 3,000 patients) survival study, the ATLAS Trial, comparing 2. 5 mg and 35 mg of lisinopril in patients with systolic heart failure, showed that the higher dose of lisinopril had outcomes at least as favorable as the lower dose The Gruppo Italiano per lo Studio della Sopravvienza nell’Infarto Miocardico (GISSI-3) study was a multicenter, controlled, randomized, unblinded clinical trial conducted in 19,394 patients with acute myocardial infarction (MI) admitted to a coronary care unit Patients receiving lisinopril (n=9,646), alone or with nitrates, had an 11% lower risk of death (p = 0.04) compared to patients who did not receive lisinopril (n=9,672) (6.4% vs. 7. 2%, respectively) at six weeks

The prognosis for patients with heart failure or acute myocardial infarction treated with lisinopril may be improved, as evidenced by:

• Reduced signs and symptoms of heart failure
• Improved survival outcomes in patients with systolic heart failure
• Lower risk of death in patients with acute myocardial infarction However, it is essential to consider the potential risks and benefits of lisinopril treatment, including the increased incidence of persistent hypotension and renal dysfunction 2.

From the Research

Prognosis Tips

• The prognosis of a patient can be improved by using evidence-based practice guidelines, which are systematically developed statements to assist practitioners and patients in making healthcare decisions 3.
• Clinical practice guidelines should be developed within the principles of bias minimization, systematic evidence retrieval and review, and a focus on patient-relevant outcomes 3.
• The use of angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs) can have different outcomes and adverse events in patients with hypertension, and the choice of treatment should be based on individual patient needs and risk-benefit analysis 4, 5.
• Healthcare professionals' evidence-based practice competencies, including knowledge, skills, attitudes, and beliefs, are essential for providing high-quality care and improving patient outcomes 6.
• The combination of metformin and antihypertensive therapy with drugs blocking the renin-angiotensin system can be a cause of concern, and patients should be aware of the risk of metformin-associated lactic acidosis, especially in cases of dehydration or acute renal failure 7.

Key Considerations

• The development and use of clinical practice guidelines can help reduce the use of unnecessary or harmful interventions and improve patient outcomes 3.
• The choice of treatment for hypertension should be based on individual patient needs and risk-benefit analysis, taking into account the potential outcomes and adverse events of different treatments 4, 5.
• Healthcare professionals should have the necessary competencies to implement evidence-based practice and provide high-quality care 6.
• Patients should be aware of the potential risks and benefits of different treatments, including the combination of metformin and antihypertensive therapy with drugs blocking the renin-angiotensin system 7.