Are Prognostic Scores Better Than Clinician Judgment? A Prospective Study Using Three Models

Hiratsuka, Yusuke; Suh, Sang-Yeon; Hui, David; Morita, Tatsuya; Mori, Masanori; Oyamada, Shunsuke; Amano, Koji; Imai, Kyoichi; Baba, Mika; Kohara, Hiroyuki; Hisanaga, Takayuki; Maeda, Isseki; Hamano, Jun; Inoue, Akira

doi:10.1016/j.jpainsymman.2022.06.008

Cited by 12 publications

(12 citation statements)

References 37 publications

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“…In a recent large multi-centre study of 1896 patients with cancer admitted to a palliative care unit, as in our study, survival estimates (using clinician’s predictions of survival or prognostic scales) were most accurate in patients with days to live. In that study however, all methods of prognostication demonstrated good performance for up to 60 days of survival, which is likely explained by the underlying diagnosis and the short overall median survival time (19 days), suggesting that patients were likely to have had more predictable trajectories [ 26 ]. In our study of patients with a variety of diagnoses and likely disease trajectories, clinicians were also good at identifying patients who were likely to live for more than one year but were less accurate at predicting survival of “weeks” or “months”.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of clinical predictions of prognosis at the end-of-life: evidence from routinely collected data in urgent care records

et al. 2023

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Background The accuracy of prognostication has important implications for patients, families, and health services since it may be linked to clinical decision-making, patient experience and outcomes and resource allocation. Study aim is to evaluate the accuracy of temporal predictions of survival in patients with cancer, dementia, heart, or respiratory disease. Methods Accuracy of clinical prediction was evaluated using retrospective, observational cohort study of 98,187 individuals with a Coordinate My Care record, the Electronic Palliative Care Coordination System serving London, 2010–2020. The survival times of patients were summarised using median and interquartile ranges. Kaplan Meier survival curves were created to describe and compare survival across prognostic categories and disease trajectories. The extent of agreement between estimated and actual prognosis was quantified using linear weighted Kappa statistic. Results Overall, 3% were predicted to live “days”; 13% “weeks”; 28% “months”; and 56% “year/years”. The agreement between estimated and actual prognosis using linear weighted Kappa statistic was highest for patients with dementia/frailty (0.75) and cancer (0.73). Clinicians’ estimates were able to discriminate (log-rank p < 0.001) between groups of patients with differing survival prospects. Across all disease groups, the accuracy of survival estimates was high for patients who were likely to live for fewer than 14 days (74% accuracy) or for more than one year (83% accuracy), but less accurate at predicting survival of “weeks” or “months” (32% accuracy). Conclusion Clinicians are good at identifying individuals who will die imminently and those who will live for much longer. The accuracy of prognostication for these time frames differs across major disease categories, but remains acceptable even in non-cancer patients, including patients with dementia. Advance Care Planning and timely access to palliative care based on individual patient needs may be beneficial for those where there is significant prognostic uncertainty; those who are neither imminently dying nor expected to live for “years”.

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Section: Discussionmentioning

confidence: 99%

Accuracy of clinical predictions of prognosis at the end-of-life: evidence from routinely collected data in urgent care records

et al. 2023

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“…In a prospective study conducted in South Korea comparing the PPS, Palliative Prognostic Index (PPI), and Palliative Prognostic (PaP) to complement the clinician's prediction of survival (CPS), it was found that CPS and PaP had consistently better performance than PPS or PPI alone. [10] Literature explained that PPS as a sole tool can be relatively accurate when there are the right circumstances, such as patients with days to live and experienced clinicians. [2][10][16] [17] According to Oğuz et al ( 2021), a shorter time scale was recommended because advanced cancer patients receiving palliative care tend to be frail and their clinical status can rapidly change.…”

Section: Discussionmentioning

confidence: 99%

The use of Palliative Performance Scale as the Sole Prognostication Tool among Patients Transferred Under Palliative Care: A Single Institution’s Experience in Qatar

Abdullah

Allam

Singh

et al. 2023

Preprint

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Background The demand for cancer palliative care services in Qatar is increasing due to the increase in the number of people with advanced cancer who require supportive measures and end of life care. End-of-life prognostication is a vital step to determine survival; however, this is extremely challenging, and requires precise tools besides clinicians’ judgments. The palliative performance scale (PPS) tool is used to prognosticate survival and to assess patients ‘symptoms at the National Centre for Cancer Care and Research (NCCCR). The aim is to analyse the correlation between PPS and overall survival (OS) and to report the experience of using PPS as a sole prognostication tool among patients transferred under palliative care at NCCCR in Qatar. Method This is a retrospective cohort study. Data of advanced cancer patients who were accepted under the palliative care program were retrieved from the electronic medical record from January 1, 2017 until December 31, 2021, to test the accuracy of PPS in estimating the prognosis and survival time. The PPS scores were compared with the dates of death for each patient. Result The findings revealed that the initial PPS is a significant predictor for overall survival, along with the type of cancer, but not with age or gender. There are clinical differences between PPS scores of ≤ 30% and those of 40% or more; therefore, PPS ≤ 30% was chosen as a cut-off value in this present study. The results revealed a statistically significant higher OS for patients with PPS of 40–80% compared to those with PPS of ≤ 30% (p = 0.03). Conclusion There is a need to couple PPS with other prognostication tools to achieve accuracy in predicting overall survival time for cancer patients under palliative care.

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“…Prognostication is a complex and challenging task for clinicians, and overestimation tendency is one of the pitfalls of CPS. CPS is reportedly quite accurate in predicting the final few weeks of survival of patients with advanced cancer; 4,5 however, it can differ depending on patient survival. 7 For intermediate survival, more research is needed to examine prognostic tools.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Recently, studies have reported that the CPS exhibits more accuracy in the prognosis of patients with advanced cancer during the final weeks of their lives. 4,5 The accuracy of prognosis is dependent on the timeframe of patient survival, and CPS is known to be inaccurate in predicting intermediate survival. 6,7 Surprise question (SQ) required a "Yes" or "No" answer to the question, "Would you be surprised if the patient died in a specific timeframe?"…”

Section: Introductionmentioning

confidence: 99%

Are Surprise Questions and Probabilistic Questions by Nurses Useful in Home Palliative Care? A Prospective Study

Suh

Yoon

Lin

et al. 2023

Am J Hosp Palliat Care

Self Cite

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Background: Surprise questions (SQs) are used as screening tools in palliative care. Probabilistic questions (PQs) are more accurate than temporal predictions. However, no study has examined the usefulness of SQs and PQs assessed by nurses. Objectives: To examine the accuracy of nurses’ SQ and PQ assessments in patients with advanced cancer receiving home palliative care. Design: A prospective single-center cohort study. Setting/Subjects: Adult patients with advanced cancer who received palliative care at home in South Korea between 2019 and 2020. Measurements: Palliative care specialized nurses were asked the SQ, “Would you be surprised if the patient died in a specific timeframe?” and PQ, “What is the probability that this patient will be alive (0 to 100%) within a specific timeframe?” at the 1-, 2-, 4-, and 6-week timeframes at enrollment. We calculated the sensitivities and specificities of the SQs and PQs. Results: 81 patients were recruited with 47 days of median survival. The sensitivity, specificity, and overall accuracy (OA) of the 1-week SQ were 50.0, 93.2, and 88.9%, respectively. The accuracies for the 1-week PQ were 12.5, 100.0, and 91.3%, respectively. The 6-week SQ showed sensitivity, specificity, and OA of 84.6, 42.9, and 62.9%, respectively; the accuracies for the 6-week PQ were 59.0, 66.7, and 63.0%, respectively. Conclusion: The SQ and PQ showed acceptable accuracy in home palliative care patients. Interestingly, PQ showed higher specificity than SQ at all timeframes. The SQ and PQ assessed by nurses may be useful in providing additional prognostic information for home palliative care.

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Are Prognostic Scores Better Than Clinician Judgment? A Prospective Study Using Three Models

Cited by 12 publications

References 37 publications

Accuracy of clinical predictions of prognosis at the end-of-life: evidence from routinely collected data in urgent care records

Accuracy of clinical predictions of prognosis at the end-of-life: evidence from routinely collected data in urgent care records

The use of Palliative Performance Scale as the Sole Prognostication Tool among Patients Transferred Under Palliative Care: A Single Institution’s Experience in Qatar

Are Surprise Questions and Probabilistic Questions by Nurses Useful in Home Palliative Care? A Prospective Study

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