The Accuracy of Probabilistic Versus Temporal Clinician Prediction of Survival for Patients with Advanced Cancer: A Preliminary Report

Abstract

Clinicians have limited accuracy in the prediction of patient survival. We assessed the accuracy of probabilistic clinician prediction of survival (CPS) and temporal CPS for advanced cancer patients admitted to our acute palliative care unit, and identified factors associated with CPS accuracy. Eight physicians and 20 nurses provided their estimation of survival on admission by (a) the temporal approach, "What is the approximate survival for this patient (in days)?" and (b) the probabilistic approach, "What is the approximate probability that this patient will be alive (0%-100%)?" for >24 hours, 48 hours, 1 week, 2 weeks, 1 month, 3 months, and 6 months. We also collected patient and clinician demographics. Among 151 patients, the median age was 58 years, 95 (63%) were female, and 138 (81%) had solid tumors. The median overall survival time was 12 days. The median temporal CPS was 14 days for physicians and 20 days for nurses. Physicians were more accurate than nurses. A higher accuracy of temporal physician CPS was associated with older patient age. Probabilistic CPS was significantly more accurate than temporal CPS for both physicians and nurses, although this analysis was limited by the different criteria for determining accuracy. With the probabilistic approach, nurses were significantly more accurate at predicting survival at 24 hours and 48 hours, whereas physicians were significantly more accurate at predicting survival at 6 months. The probabilistic approach was associated with high accuracy and has practical implications. The Oncologist 2011;16:1642-1648

Clinical Signs of Impending Death in Cancer Patients

“…Clinicians often overestimate survival [4,5] and hesitate to make the diagnosis of impending death without adequate supporting evidence.…”

Longitudinal Temporal and Probabilistic Prediction of Survival in a Cohort of Patients With Advanced Cancer

“…Temporal CPS was obtained by asking clinicians “What is the approximate survival of this patient (in days)?” Probabilistic CPS was obtained by asking clinicians “What is the probability that this patient will be alive (0% to 100%) in 24 hours?” and “What is the probability that this patient will be alive (0% to 100%) in 48 hours?” (6) Patients who were discharged alive were followed until death or lost to follow-up.…”

“…Healthcare providers are inaccurate in estimating survival for cancer patients (5–10). Temporal CPS has reported accuracies between 20% and 30% (5, 6, 8, 11). Few studies have examined the accuracy of the probabilistic CPS in patients with advanced cancer (6, 12).…”

“…Temporal CPS has reported accuracies between 20% and 30% (5, 6, 8, 11). Few studies have examined the accuracy of the probabilistic CPS in patients with advanced cancer (6, 12). In a prior study from our group, we showed that clinicians were more accurate in estimating survival with probabilistic CPS than with temporal CPS (6).…”

Prognosis Prediction Models and their Clinical Utility in Palliative Care

“…The accuracy of physicians' prediction of death within 24 and 48 h was 71-73% and 66-67%, respectively [15,20]. Interestingly, nurses showed more favorable predictive performance than physicians using the probabilistic question, and the accuracy of their prediction of death within 24 h and 48 h was 90-91% and 83-86%, respectively [15,20].…”