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Prognostication and Communication in Oncology

It is exceedingly difficult to make predictions, particularly about the future." —Neils Bohr

I am privileged to be part of such a great team of #ethicists working on challenges with communication of prognosis. Prognostication is an art as much as it is a science... particularly when it comes to discussing the management of highly complex and chaotic systems like cancer. While we often discuss predictions in terms of expectations of future climate, we often neglect or are unprepared to discuss the storms our cancer patients will face. Many times we do not properly communicate the uncertainty of our predictions... this is like presenting data without error bars - we imply we know exactly where future outcomes will happen when there are actually a range of possibilities.

I am a huge fan of the work of Nate Silver, who condenses a good prediction into three metrics:

1) Accuracy - did the actual weather match the forecast?

2) Honesty - did the forecaster do their best to relay important information?

3) Value - did the forecast help us make a better decision... grab an umbrella, or get our affairs in order?

When we create good predictions in medicine, we must translate fairly complex information into something actionable by patients... remember 'docere' means 'to teach', doctor!

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