Prediction of Patient Survival by Healthcare Professionals in a Specialist Palliative Care Inpatient Unit: A Prospective Study

Abstract

Accurate prognostication is an enormous challenge for professionals caring for patients with advanced disease. Few studies have compared the prognostic accuracy of different professional groups within a hospice setting. The aim of this study was to compare the ability of 5 professional groups to estimate the survival of patients admitted to a specialist palliative care unit. No group accurately predicted the length of patient survival more than 50% of the time. Nursing and junior medical staff were most accurate while care assistants were least accurate. When in error, senior clinical staff tended to under-estimate survival. Independent mobility on admission was the only variable predictive of length of survival. Thus, professional groups differ in their prognostic accuracy. An awareness of a group's propensity to over- or under-estimate prognosis should be incorporated into future work on prognostication models.

Factors Influencing Survival after Discharge from an Australian Palliative Care Unit to Residential Aged Care Facilities: A Retrospective Audit

“…18 Dependent mobility represents a simple, practical indicator of reduced functional capacity and in the univariate analyses impacted upon survival time after discharge from a PCU to an RACF. This finding mirrors that of Twomey et al 22 who found independent mobility to be a predictor of length of survival, with nonindependent patients at PCU admission being less than half as likely to survive as long as those able to mobilize on their own.…”

Nurses and Physicians in a Medical Admission Unit Can Accurately Predict Mortality of Acutely Admitted Patients: A Prospective Cohort Study

“…However, their precision (calibration) was poor, and their predictions were generally too optimistic. This phenomenon has been previously shown in various other settings [17]–[19]. However, a well-performed meta-analysis on physician prediction in the ICU setting showed that physician predictions of mortality were more accurate than scoring systems [6].…”

A Systematic Review of Predictions of Survival in Palliative Care: How Accurate Are Clinicians and Who Are the Experts?

“…Of the 42 studies included, 20 reported prognostic estimates using only a categorical approach [19, 20, 25–27, 30, 34, 36, 37, 40–42, 45–47, 49, 55, 56, 58, 60], 16 reported only continuous estimates [21, 22, 24, 28, 29, 31, 33, 38, 39, 44, 48, 50–53, 57] and 3 studies reported only probabilistic estimates [32, 43, 59]. Two studies used both categorical and continuous estimates [23, 54] and one study reported all three types of estimates [35].…”

“…Two papers could not be included in the forest plot because the relevant data was not available. Twomey, O’Leary, & O’Brien [30] reported that clinicians were just as likely to overestimate as to underestimate survival. Casarett, Farrington, & Craig et al [42] reported the c -statistic for the accuracy of predicting death between one and 10 days.…”

“…job title or specialty) [19, 23, 24, 27–30, 38, 58]. Five papers reported the experience of the clinician; either in years, or narratively [20, 21, 25, 26, 31].…”