X-Message-Number: 3875
From:  (David Stodolsky)
Subject: Fwd: Computer Aids in Predicting Death
Date: Sun, 19 Feb 95 10:53:45 +0100 (CET)



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Date: Thu, 16 Feb 95 21:28:46 -0800
From: Lauren Wiener <>
Subject: Computer aids in predicting death

>From _The Oregonian_, 16 Feb 1995, p. D11:

Computer Aids in Predicting Death, by Mike Koller, AP, Philadelphia

[...] Using a new program, researchers say they are able to predict when a
terminally ill person will die with more accuracy than doctors using their
own judgment.  The study could help doctors determine which treatments
should be given to terminally ill patients and help decide when life-support
efforts should be stopped.  ``The computer remembers thousands and thousands
of cases and keeps the different risk factors in perspective," said Dr.
William A. Knaus of George Washington University.  Knaus led the study,
published in the Jan. 31 issue of the Annals of Internal Medicine.  ``And
when we included the survival estimate from the patient's own physician in
the model, the two together predicted time until death more accurately than
either alone," he said.  The program was developed from June 1989 to June
1991, using information from 4,301 patients.  It was tested from January
1992 to January 1994 on 4,028 patients, Knaus said.

The program, called SUPPORT (Study to Understand Prognoses and Preferences
for Outcomes and Risks of Treatments), focused on nine diseases and
conditions, such as liver disease, colon or lung cancer, heart or lung
disease and multiple organ failure.  Knaus said he was confident that
Support will prove reliable and eventually be expanded to predict death
rates for other diseases.  Seriously ill patients with a projected life
expectancy of six months were entered in the study when they were
hospitalized.  [...]

``Most adults say that if they are going to die within a year, they want
realistic estimates of their risks, both in the immediate future and during
the next few months," Knaus said.  ``This predictive tool is important for
its use for counseling very sick patients and their families."

However, not everyone agrees.  Toby Gordon, vice president for planning and
marketing at Johns Hopkins Hospital and Health Systems in Baltimore, said
the program raises questions.  ``Any information that helps us learn how to
better take care of patients -- in quality of care and quality of life --
makes a contribution," Gordon said.  ``But whether patients and their
families will want to use it is questionable."  He also questioned the
ramifications of being able to accurately predict death.  ``In the expansion
of computer-assisted technology we will see a proliferation of these
techniques, bringing into question ethics and rationing of care," he said.

The authors warned that the project has not been tested outside the strictly
controlled settings of teaching hospitals.  Its reliability in conventional
hospitals settings has not been established, they sa

David S. Stodolsky, PhD  * Social *   Internet: 
Tornskadestien 2, st. th.   * Research *    Tel.: + 45 38 33 03 30
DK-2400 Copenhagen NV, Denmark  * Methods *  Fax: + 45 38 33 88 80



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