The SUPPORT Prognostic Model: Objective Estimates of Survival for Seriously Ill Hospitalized Adults

Knaus, William A.; Harrell, Frank E.; Lynn, Joanne; Goldman, Lee; Phillips, Russell S.; Connors, Alfred F.; Dawson, Neal V.; Fulkerson, W. J.; Califf, Robert M.; Desbiens, Norman A.; Layde, Peter M.; Oye, Robert K.; Bellamy, Paul E.; Hakim, Rosemarie B.; Wagner, Douglas P.

doi:10.7326/0003-4819-122-3-199502010-00007

Cited by 496 publications

(243 citation statements)

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“…In contrast, to others, this time simply represents a prolongation of suffering, and thus, the discontinuation of futile interventions is a practical necessity. 25,26 In Korea, the general population regards the discontinuation of any treatment for patients with terminal malignancies as a passive form of euthanasia. Thus, the role of the physician in end-of-life decisionmaking is somewhat difficult.…”

Section: Discussionmentioning

confidence: 99%

Discrepancies among patients, family members, and physicians in Korea in terms of values regarding the withholding of treatment from patients with terminal malignancies

Kim

Lee

et al. 2004

Cancer

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BACKGROUND The role of the physician in end‐of‐life decision‐making is complicated. To analyze the controversies that surround therapeutic decision‐making and the withholding of life‐sustaining treatments, the authors compared values regarding therapeutic intervention that were held by physicians and family members of patients with terminal malignancies. METHODS One hundred fourteen patients with either advanced‐stage or terminal disease were enrolled in the current study. Questionnaires were administered to the duty physician and to patients' family members. The questions covered issues such as the use of new anticancer agents with only partial efficacy (15%) and the use of opioid analgesics, intravenous nutrition, feeding tubes, antibiotics, and hemodialysis. In addition, participants were asked about the administration of cardiopulmonary resuscitation (CPR) and the use of ventilators, and when the patient's family consented, the same questionnaire was administered to the patient as well. RESULTS Seventeen of 114 families refused to answer the questionnaire. Of the 97 available families, only 14 permitted access to the patient. Of those 14 patients, 5 refused to complete the questionnaire. Overall, 100% of families and 87% of patients had some knowledge regarding malignant disease, but only 69% of families and 37% of patients clearly understood the stage of the patient's disease. The use of a new agent with only partial efficacy (≈ 15%) was accepted by 41% of physicians and by 60% of families. The concordance rate between patients' physicians and family members regarding the same patient was 42%. The rankings of the acceptance of treatment by physicians were as follows: opioid analgesics, 100%; antibiotics, 91%; feeding tube, 87%; and intravenous nutrition, 78%. The rankings of the same items by family members were as follows: opioid analgesics, 92%; antibiotics, 89%; intravenous nutrition, 86%; and feeding tube, 75%. The concordance rates between patients' physicians and families were lowest for ventilator application (39%) and CPR (47%). CONCLUSIONS Values held on issues such as therapeutic decision‐making and the withholding of life‐sustaining treatment for patients with terminal malignancies were discordant between physicians and family members. To resolve controversies regarding the role of the physician in end‐of‐life decision‐making, the values of physicians, patients, and family members should be considered in the final decision‐making process. Cancer 2004. © 2004 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Discrepancies among patients, family members, and physicians in Korea in terms of values regarding the withholding of treatment from patients with terminal malignancies

Kim

Lee

et al. 2004

Cancer

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“…A substantial amount of data is censored and also missing. The SUPPORT data set is a random sample from Phases I and II of the SUPPORT [9] (Study to Understand Prognoses Preferences Outcomes and Risks of Treatment) study. As suggested in [7] we split the data set into four different subsets, each corresponding to a different cause of death (SUPPORT-1: ARF/MOSF, SUPPORT-2: COPD/CHF/Cirrhosis, SUPPORT-3: Coma, SUPPORT-4: Cancer).…”

Section: Results On Benchmark Datamentioning

confidence: 99%

Privacy-preserving cox regression for survival analysis

Fung¹,

Rosales²,

Krishnan³

et al. 2008

Proceedings of the 14th ACM SIGKDD International Conference on Knowledge Discovery and Data Mining

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Privacy-preserving data mining (PPDM) is an emergent research area that addresses the incorporation of privacy preserving concerns to data mining techniques. In this paper we propose a privacy-preserving (PP) Cox model for survival analysis, and consider a real clinical setting where the data is horizontally distributed among different institutions. The proposed model is based on linearly projecting the data to a lower dimensional space through an optimal mapping obtained by solving a linear programming problem. Our approach differs from the commonly used random projection approach since it instead finds a projection that is optimal at preserving the properties of the data that are important for the specific problem at hand. Since our proposed approach produces an sparse mapping, it also generates a PP mapping that not only projects the data to a lower dimensional space but it also depends on a smaller subset of the original features (it provides explicit feature selection). Real data from several European healthcare institutions are used to test our model for survival prediction of non-small-cell lung cancer patients. These results are also confirmed using publicly available benchmark datasets. Our experimental results show that we are able to achieve a near-optimal performance without directly sharing the data across different data sources. This model makes it possible to conduct large-scale multi-centric survival analysis without violating privacy-preserving requirements.

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“…Commentators have noted that physicians typically make poor judgments about survival in terminally ill patients; both unduly pessimistic prognoses (with consequent early referral to hospices) and unduly optimistic prognoses (with late referral) may have adverse effects. [37][38][39] Unfortunately, few studies have examined the process of prognostication in patients in hospice 40,41 or hospital 42 settings.…”

Section: Discussionmentioning

confidence: 99%

Survival of Medicare Patients after Enrollment in Hospice Programs

1996

N Engl J Med

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The SUPPORT Prognostic Model: Objective Estimates of Survival for Seriously Ill Hospitalized Adults

Abstract: A limited amount of readily available clinical information can provide a foundation for long-term survival estimates that are as accurate as physicians' estimates. The best survival estimates combine an objective prognosis with a physician's clinical estimate.

Cited by 496 publications

References 0 publications

Discrepancies among patients, family members, and physicians in Korea in terms of values regarding the withholding of treatment from patients with terminal malignancies

Discrepancies among patients, family members, and physicians in Korea in terms of values regarding the withholding of treatment from patients with terminal malignancies

Privacy-preserving cox regression for survival analysis

Survival of Medicare Patients after Enrollment in Hospice Programs

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